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FOR OFFICE U I 5 �D �4 - - - Ga-Ii APPLICATION__- _- --_--. APPLICATION FOR SANITATION PERMIT Permit No. .1. d�-_S - ' ------------- -t/---------------- (Complete in Duplicate) a ------ -------A-1-1----1------------------ ate Issued Date Issued 1--�--�--1-�--=-�'� _ 'This-Permit Expires ]� Year From Date Application is hereby made to the San Joaquin Local Healfh 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 AN LOCATION__ ��--r/�----- - - .----__- ..- - oo Owner's Name---=-- s ---------------------;-------- ----•------------------------------------------- -------- ------------------ - Phone............... Address--...... //. --------•-----------------------------------•-•----- .:...-....---------------------•--•----------------------------------------•-I�---------••----- Contractor's Name------- -- - •----•-•----••` <` ------------------------ -------••------ Phone----------•--�.-.. --------- If Installation will serve: Residence ❑ Apartment House; _] Comrnercial [Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----:_-_ Number of bedrooms -------- Number of baths -1 --- Lot size --------------------------------------11-------------..--.-.._ Water Supply: Public system ❑ '.Community system [] Private —,Depth to Water Table ya'f}• � Character of soil to a depth of 3 feet: iSand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ TNSTALLATIONAND 5PECIF[CATIONS:. - No R3'— New Construction: Ug--No � PFvious Application (if yes,clat! Yes No ❑ FHA/VA: YesNo ® TYPE OF (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- Septic Tank: Distance from nearest well,-It4 ----Distance from foundation_-lo._-_-----.---Material---W---------------------------------------- No. e w----------------------------No. of compartments---- -----------------Size----- - xsxq---..----Liquid depth-----3-..-------------._Capacity__$'On _ �i 1 bispos`al Field: Distance from nearest well.-.- .-..-Distance from foundation.- .G °_._.Distance to nearest lot line--------- Number of lines----------------- --------_-------Length of each line-------ya_.---------._----Width of trench.-----�`1..,-------------- .Type of filter material------ ------Depth of filter material----- --`.---.-----Total length------n-�'.:-.:...____ Seepage PitDistance to nearest well...-- ------------Distance from foundation----C-9---------.Distance to nearest lot line---s---------- [, Number of pits---------J--_---------Lining material.--70C_,(------Size: Diameter---3 __`----------Depth--------�:5----------------- ,. _ � - � 1. Cesspool:A Distance from nearest well-----------------Distance from foundation-------------.------lining material--------------------------------------- ❑ _ Size: Diameter--------------------------------------Depth---------------------------------------------- _Liquid Capacity--------- i!- ------..gals. Privy: Distance from nearest well .............Distance from nearest building------------------------------------------ Distance ---------,-------- __---_-----.-------.Qistante to nearest lot Ione. ------------ ------------------------ Remodeling and/or repairing (describe) --•-----...---- --•--•..----------- ---------- r i :a ----------------• ------------------------------------------------•--•------------------------••-----------------•-----------.------------------------------------------------------ II- I hereby certify that I have-prepared this application and-that the work will'be done in accordance with-San Joaquin-County I ordinances, State laws,and rules and regula 'ons of the San Joaquin Local Health District. H. l (Signed)----------------------------------------------- - ------ ---------- :---- ------------------------------ ----------------------------- ----...(Owner and/or Contractor) By:---------------- ---- =----------; ---------------------------------------------(Title)--------- ----- -- ------------ --------------- (Plot plan, showing size o lot, n of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Ar F ----------------------- DATE---�.2 --r1. - -- -••-------- REVIEWED BY----- ------------------------- r = _ - DATE = = BUILDING PERMIT ISSUED--_'---------------------------------------------------------- Alterations and/or recommendations:-------- "--- _ - -•------••------------------ -- ---------------------------------------------- ----------=----------------------- t } <.-..._ `- -• i r�l9 ` �'s_ ..- y f is ----------------- ---- -------------------- i 9 I; FINAL INSPECTION BY: 9 " ` ^ _ - Date------- ( -Q--------------------------------- 9 SAN JOAQUIN LOCAL HEALTH DISTRICT ' it 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 911.4 FEV1@EC 8.59 F.P.CC,2M 6.691