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FOR OFFICE USE: — � -'-R --------------------------------- ------------------ --------------------------- - --_-------------------___.- ------------- APPLICATION FOR SANITATION PERMIT Permit No. f_ --------- - ----------------------------:..-- ----------- (Complete in DujiTicate] -- This Permit Ex fres 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. JOB ADDRESS A D LOCATION: IZj�a__e--f-d__. _ Owner's Name r-r�---------- +rye f`- t-*• ; -------- - -- Phone. , 5�.�•� °= - Address__... - - c3---------------- Contractor's Name___ � ' - -------------- Installation - Phone one-;------ - Installation ----•----------------------------•- will serve: Residence., Apartment House ❑ Commercial �I Trailer Court ❑ �MotelY❑ Other ❑ Number of living units: -/ .__'Number of bedrooms j--- Number of g'aths _ .-- Lot size... ---_t--------------------- Water Supply. Public system ❑ jYCommunify system E] Private 2 Depth to-Water Ta'&e 4'._ ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 1K Clay Loam ❑ Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,Idate__._______----„---) No •1' New Construction: Yes E] No FHA/VA: Yes F] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)1 01 f Septic Tank: Distance from nearest well ----Distance from foundation--___ .__5 -- Material__� �t� --------------------- �w P No. of compartments--- ------- ---------------Size------------------------------_.Li Liquid de th_-- - I q p r Capacity- '®t Disposal Field: Distance from nearest weH_4- ?O! Distance from foundation____ D`,----Distance to nearest lot line_- S f ® Number of lines ------ __.___Length of each line: f -�0---�_-. 'r .� 9 -- ----------i t Width of trent} `;'----------------------- (� , Type of filter material __- � ----Depth of filter material____ '_ Total length---__-r �---------------------- 1 • Seepage Pit: Distance to nearest well______________________Distance from foundation------------------- Distance to nearest lot line__.. __ ❑ Number of pits.)------- -----------Lining material--------- ---- -.--- Size: Diameter------------------ ----Depth--------------------------- Cesspool: Distance from nearest well_________________Distance from foundation.__________. ---_.Lining material__---...._.__---__.__-.._____- ❑ Size: Diameter--.1 Depth - -------------------Liquid Capacity--- ----------------- gals. Privy: Distance from nearest well-__________________,._____- - „� - _.___._..___....-Distance from nearest building______________________________ Distance to nearest lot line_____________________ _- -------------------------------- Remodeling and/or repairing (describe):_-- Q-_- � ------------ -------------------- -------- ----- ! 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 San Joaquin Local Health District. (Signed) A/- �, - A �-�---------------------------------------------------------- ------Owner and/or Contractor] 8Y= ---------------------•----- --------------- g Title (Plof plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 _. - --------------------------------------------- DATE_____ *__ - --------------------------- VIEWED BY - - -- ----------------- ------------ DATE - ------------------------------------------------------------ BUILDING PERMIT ISSUED ---------------------- ---------------------------------------------- ------ DATE - - -------------------------- Alterations and/or recommendations:-----------------_ ------------------------------- ------------------ --- -----------------------r---------------------------------------------- - ------------------ `i--- ----------- --- -------------------- --- --------------------------------------•--------------•------------------ ---------------------- ------- -------- - ----------- --------------------- ------------------- --------- ------------ ----------------- --------- ------------ ---------•----- ----------------- - ----- ------------ FINAL INSPECTION - -�-.F --- - ----- Date---- ------- ----- �--�-- ------ ----- - a SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California •o ;,; Manteca,California Tracy,California F'.P.CO.