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z FOR OFFIjCJSE: 4 t 1' -- �__-____ APPLICATION FOR SANITATION PERMIT Permit No. ...�`.. _.T .Z ---------------------- Date Issued ...(Complete in Duplicate) ..---_...__._...-. _. ............. ... This Permit Expires 1 Year From 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 JOB ADDRESS AND LOC ON J fit ----------------- -,�!: Owner's Name---- =-------• .. Phone.9.#�'--------Zi�,_•x-7 e Address---------------_ .------- ---- --- -------- ---- -- ..................................................- Contractor's Name-- .... =•�.l.s:-- --•------------------------------------------------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Other Number of living units: ....1__ Number of bedrooms _,?- � . Number of baths _. Lot size � �- -• -------- Water Supply: Public system ❑ Community system ❑ Private [0- 6epth to Water Tabl s _ tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe UK-Hardpan ❑ Previous Application Made: (If yes,date--------.-----------) No M----New Construction: Yes Ef-14_o ❑ FHA/VA: Yes ❑ No Ej-_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank• Distance from nearest well_________________Distance from foundation....................Material___....._,-__...-...-.--..-----•-__--...__-.-__-- No. of compartments...------•---------------Size--------------------------•• Liquid depth--------------------------Capacity----------------------- Disp al-Fi Distance from nearest wellb-V-i...........Distance from founclation.sfI9.-1........Distance to nearest lot line....0 j.... JNumber of lines__.___..�_____________________Length of each line--------- :,5._............Width of trench..---•-•-�:y-•r-•••-•---•-••- ��C Type of filter material� ..._._-.__..Depth of filter material.....1Ff_`---------Total length-._.-._....I4 ...........I....... Seepag Pit: Distance to nearest well-42-0------------Distance from fo ndation.14!e ...Distance to nearest lot line_..6.......... Q [ Number of pits.......2------------Lining material..`.... - ---Size: Diameter-_-3-3..........Depth....... .................... Cesspool: Distance from nearest well-----------------Distance from foundation--------------..._..Lining material.--...._.__._...._.--___-.-._...-_.-. � ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------.-----------------------------------Distance from nearest building......:.-_.-_-_;____---------_.--..--_-._. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- ---------------••---•--•-----------------•- Remodeling and/or repair'ng (describe) 1 - 1.-- ��a ----- ' ---- •--•----•-_- -_----.--------- -------- -.- t I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules d r gulations of the San Joaquin Local Health District. -----_--Owner and/or Contractor By:............... - - ------- ---------- ----- ----------------------------------------------------------------------------(Title)---------- ------------------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ - R DEPARTMENT US ONLY APPLICATION ACCEPTED BY----- _ = � � :=ti'----•------ DATE. ¢.. REVIEWED BY............................. -----------------------------------------------------------------------------•-----.- DATE------ •---•---...--••---•-••-•---- BUILDINGPERMIT ISSUED....... --------------------------------------------------...................................... DATE. Alterations end/or recommendations:--.,1:_O `.... __..- c. 4 .._. ;_ .__. - ....:........................ t/ ------------------------------------- ----�---- ---------- =-------------- -----------------------------------------------------------•---= ------ ------------ .................. -•--------------------------------------------------•---------------------..........------. ------------------------------------ FINAL INSPECTION : .��,5 J...�_. _. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,-CaNfornia Lodi,California Manteca,California Tracy,California ER-9 REVISED 8.69 r.P.DD.2M 6.60