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FOR OFFICE USE: -------------------------- ------------------------------ --------------------- ------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. r �.4...a. ..... ------------ -------------------------------------- ` (Complete in Duplicate) L Date Issued __...................... ---------------- ,� 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 L CATI ----- ---�J- �_ 1 r +�I� { - iQ 1�- - �sl. dr`. N Owner's Name ----- - Phone.- -2 hone. I 1&P-----X&... e-�c-------- C - f Contract----- ----- •- ---- / --�- - - ---•- Address { = --".-GG �k __. -•-•----- --�' Gr` , o /.fid W L or's Name---- --a------ ----;-. --`� -- �----------�iR.-�--------�-----------------J��------�`��------•- - Qhone- Installation will serve: Residence N]Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel/❑ Other ❑ Number of living units: j-.-. Number of bedrooms .. __. Number of baths ---4- Lot size _--�� _.K_-r `� ------..__------ _- Water Supply: Public system ❑ Community system ❑ Private*' Depth to Water Table .tr_`ft. Character of soil to a depth of 3 feet: Sande Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan p _ Previous Application Made: .(if yes,date...-.--- ) Noj?_.New.Construction: Yes,,❑—No Lk.,. FHA/VA:mYes ❑.A No ~ ...r. -_._. , TYPE OF INSTALLATION AND SPECIFICATIONS: `` ( , (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well_-__+�.®_---Distance from fou�ndation-_/a-�_.-_.. MateriaL� ----------- --------------------------- No. of compartments______ _______________Size_.. .X-��.X.�f Liquid depth-..-_0..-.--._._-----Capacity,�i!5 Disposal Field- Distance from nearest w0___%1V_."-.Distance from foundation---CA_ ------.Distance to nearest lot line.._,S77�7..... ( ' � - Length of each line-------�(1`��....--.Width of trench' ' `................ * ' Number a# lines.._..._. Type of filter material.. .a.4/ff......Depth of filter material..l9..............Total length---_i .l _-...._.----------------- Seepage Pit: Distance to nearest well .....................Distance from foundation------------------- Distance to ne&est lot line..._............. Ale Number ofpits .-. ___A-----------------Lining material---------- --------. Size:Diameter'.:`""""�_,� _ --Depth--------------------------------- Cesspool: Distance from-nearest well---- -----------Distance from foundation....................Lining �material.......-___---.---------.-..-_---.-.. ` El Size: Diameter--------------------------------------Depth------- --------------------------------------------Liquid Capacity----------------------------gats. =Privy: Distance from nearest well---------------r____________________________----__Distance from nearest building..-;.__.-_._.---.._..__.._.- ❑ Distance to nearest lot line.:,.-------:---------------- ----------- i Remodeling and/or repairing __== - =----------------------------------:------------------------ --- =_=-----•----------------------- ' .L r -------------I------_----•- = --------------------•-----------------------•--•---- -------------------------------------------------------------------- —--- --------------------- .r , .rs ------------------------------ ------- '-------------•---------_------------- -----------•--------•-•----------••----- ------------•-------•-----------------------------------------------•-------------------------------- t' 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 andlregulat;ons of the San Joaquin Local Health District. ---..--- ' -=---- -_ --- -- -- _ = —Owner-and or4•Contractor ------ ---------(rifle)--- - ---- - ---- BY _.... .. .... -- ------------------- (Plot plan, showing size of to , location of ystem in elation to wells, buildings, etc., can be placed on reverse side). - FOR'DEPARTMENT USE ONLY F -- --- ex _..;x ofw------------------------- APPLICATION ACCEPTED BY--- - - ------------------- DATE-----------�..�.:/=Z.�.----------=----------- - REVIEWEDBY- ------------------------------------------- -------------------- ---------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------,----------------------------------- Alterations and/or recommendations-------- --- -- -- --------- ---------------------------•------------------=-----------------'------- --------------------------------------------•---------- _..........................-.._._.......-............-....._-...-.......-.-.-_..-...-....-.................--------------- -------------------------- --------.------.-------------------------------------------.--------- -----------_•--------••-----•-•------------------------------------------ ---------------------------- ----------------------------_ _....--•------.- ._------------------------------------------- --------- ---------------------------------------------- ------------ --------........................................................... ---------------------------------------1..----------_-------- .. -• FINAL INSPECT Dafie `. 3 '. - ''- ------•---- I SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California , Manteca,California Tracy,California F.P.CO. 1