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FOR OFFICE USE: ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...��_`..... _ ----------- 4- --t (Complete in Duplicate) '} This Permit Expires 1 Year From Date Issued Date Issued .vZ.r.L_l=.fab 1/ 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. JOB ADDRESS AND LOCATION.-I__3_""� �O__.Q .__' __-_....__.. __ ..... _90. .�y�....�!'�_.. .. 9` Owner's Na a f-------------4----------o- Phone_ -----•--------- --------••••--•-------•-------..... Address3 > ;1 ........------•-------------------------•--- LCont --------- -------- --•-- -------- Phone.V/ fY ractor's Name Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./--'Number of bedrooms c;2--- Number of baths .-/-. Lot size ------------- ................. Water Supply: Public system ❑ Community system ❑ Private [Erlbepth to Water Table 94�ft. f Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No [-FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic ank: Distance from nearest well_________________Distance from foundation---------------.___.Material_-____-._-__-_.-__-_____,_____-_-____-_____-____. No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well.A0_'___tDistance from foundation..,.14.__________.Distance to nearest lot [L� _-- line�S__ �.� Number of lines_____ ______ _Length of each line------R_ 3i____-____-Width of french------ f. �-._-_____-__ ---------- Type of filter me __ Depth of filter material _g__. ____Totalength__..__.-____._____.� _._._.___ , Seepage Pit: Distance to nearest well ---_t_Distanc m founclation_`.1..........Distance to nearest lot line- Number of pits------/-- __ -_-.______Lining material_ _C __-Size: Dia meter-__�,� ---.-------_Dept h...... ______________ Cesspool: Distance from nearest well-----------------Distance from foundation.---__---_--______-.Lining material------------------------------------- 171 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity-- -------gals. tr Privy: Distance from nearest well____________________________________ __________Distance from nearest building------------------------------------------ ElDistance to nearest lot line----- ------------------------------------------------------•------------•-----•-------------------•--------------.--------------------- Remodeling and/or,repairing (describe)------------------------------------------ ........-----------------------•----•---------••----••----------•--------•-------------------•----•-•-------_- -----------------•-----•----------------------------••------••-----------•------••------------------•------------------------------•----------------------------------------------------------------•------------------------ --------------------•----------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- -----------------------------------•------------•--------------•-----_•-------------_•---_---•---------------------------------------..---------------------•-----------•----------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the an Joaquin Local Health District. (Signed)-------- -- --- ----- ... ----------------- -- ------(Owner and/or Contractor) BY: -------------------(Title) - --------- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 11-4 APPLICATION ACCEPTED BY---- ----- e-------------------------------------------------------- DATE.....02--'- /j-----4060------------------------- REVIEWEDBY--------------------------------------------- ---------------------------------- --------------------------- ----------------- DATE----------------------------------------------•------- BUILDING PERMIT ISSUED----------------------------------------------------------------------- DATE - - Alterations and/or recommendations:______.T _G��_-__me----L___ ............................................................... ---------------------- ------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------•------------------------------------------------. --------------------------------------- -------------------------------------------------------------- ------------------------ ----------------------------------------------------- ............... ------------------ ----------------------------- --------- --------------------------------- -- --------=-------------------------------------------------------- ------------------------ -----------•------------------------ -----•---- FINAL INSPECTION BY:..v-Z._W. _ ---------------___--- Date_- I/. &(0 --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.