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FOR OFFICE USE: tS .......... .......... APPLICATION FOR SANITA-TION PERMIT Permit No. ........-://-1 -----. - - ----- -------------- (Complete in Duplicate) _ - This Permit Expires 1 Year From Date Issued Date Issued_- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein,described. This application is made in compliance with County Ordinance No. 549. J . Cl ---------_-JOB ADDRESS ANDOCATION - Owners Name-------- - ---_---------- --- --- - Phony- --------- Address _ Address------------------------------- -- ..- --------------- --- - -- ----------- --------------------------------.-:. ---•-------=- - Contractor's Name.------ Y.--. .----------- ---- - ------ - • - - --------- -- - - ---------------------------....... Phone.. -- ---------------------------- Installation ----------- ------- --- Installation will serve: Residence U--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --,—Number of bedrooms __Number of baths 2--- Lot size ._._ -_ ? �.............. / ----X------Z---- Water Supply: Public system ❑ Community system ❑ Private 2,-_D'epth to Water Tables ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam El Clay El Adobe ®hardpan E] Application Made: (ff yes,date _.__ ------ ) No New Construction: Yes [g�-<o ❑ FHA/VA: Yes FT_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest.-.w--. .... � Distance from fou,dation__,. /..... _-. No. of compartments - i - -5 -e ---- - Liquid depth------ Capacity--- 7. Disposal Field: Distance from nearest well .5 __Distance from foundation-_/Q_....---..Distance to nearest lot line--_- .�_. ❑ 11— Number of lines _._ _`. ..............Length of eachWidth of trench----- Type of filter materiai___ -. .---- --.Depth of filter __Total length----- i�./----- i 1 Seepag it: Distance to nearest well._�1�._.__-------Distance from foundation__... Distance to nearest lot line.. ------- -Number of pits-;- -- --.- ....Lining material--,� tJ - - ---Size: Diameter_=67/_____ Depth-----�4'..-------------------- Cesspool: Distance fi-om nearest well -Distance from foundation .. .............. Lining material____________ - J� ❑ Size: Diameter- - --- - -- ----- -------- -- -----Depth .------------- --- - - ------Liquid Capacity- --------------- -- -gals. {.l Privy: Distance from nearest yell------------- - --------------_. .. .. ._Distance from nearest building.---..--------------------- Ll Distance to nearest lot line - -- --- ----------- _ . . --------------------------------- --- - - ----------- Remodeling and or repairing descrkbe :- - ------ Y---------S-65 - -� --------------------------------------------------- ------. .-------- ----------- ---------------------------------- -- -------- -- ------ - - ------ --------- ---------- - -- ---- -------------------------------------------------- ------------------------------------------ ------------------------ -I----------- ----- ...... --.. .. I hereby certify that I havere tired this app' tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es an regulationof t e San Joaquin Local Health District. (Signed) Owner and/or Contractor) By: -------(Title) lih 2� (Plot plan, showing size of lot, I n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �C� �, }_ -"��rLJ --- ------ - --- - DATE--- 1-c'-L'Aft'. -------- --- ----------- REVIEWED BY----- ------------------- ----- DATE------------- -------- - ---- - BUILDING PERMIT ISSUED------------------------ -------------------------------------------------- -- ...... -----. DATE---------------------------------- -- - ------ .......... Alterations and/or recommend tions. ., > fs K..i �,.. - --------------------- ---------------- --- -------------- ----- - --- ------ ---- -------------- - - - - ------------------ ---- -----..... -- --- - -- - ---------- ---- -- . .... .... .. . . ..._._ . .._...._..---------- ----------- ----------------- FINAL INSPECTION BY:.. ,,�r°.. - Date_...- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 129 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P CO.