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rUKUrrl(-.t USt: ------------------ ------------------------------------- ' __________________________________-___.__ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------- --------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _` '_a.---__----- 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 comp]ibncejwii Qrdinance No. 549. � c JOB ADDRESS AND LOCATION__23__2r. __._ ----_-- ------------------------------------------------------------------------------------- Owner's Name --------- ---t----------------------------------••------------------ - ------------------------------------------- Phone----------- Address-----•----_--70 ---------�� ®--------- -.. t ice` Contractor's Name----Df[f'--',� cp. . -------• (�•�t- ----- Phone__ '7-�'-06 d. p ❑ Y. Installation will serve: Residence Apartment House Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I_-' Number of bedrooms :1_ Number of baths _/----- Lot size ____.____.� �- Water Supply: Public system Rd Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5• Hardpan ❑ Previous Application Made: (If yes,date----------- Nog New Construction: Yes rul No ❑ FHA/VA: Yes ❑ No ❑ 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 foundation----/6_____; No. of compartments---- �L------- Size---- r2—)----Liquid depth--------- - f--- -----Capacity--- -�--• ®ispo I Field: Distance from nearest we11---___ -------Distance from foundation....In---------Distance to nearest l� line--- Number of lines------------/ -- --------------Length of each line-------Zn�-r-......'---.Width of frenal---z_---------------•----------- T e of filter material_.__.A' `` Yp _---Depth of filter material------/ ---. --:---Total length------- CJ-_f_._______________•---- W / OQ eep ge Pit: Distance to nearest well----__�._.______Distence from foundation___l�_�--_-.Distance to nearest lot line__.____.. Number of pits_-___-.-._�___-___---Lining material----- Diameter.-._____-_—.___ _ j I �. De th--------��------------------ Cesspool: Distance from nearest well-____-_____.-__Distance from foundation------.-------------Liningmaterial-------------------_---------------., i\ ❑ Size: Diameter-1------------------------ -- ---.----Depth------ --------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------- ---------------------- ---__-----k---Distance from nearest building ❑ Distance to nearest lot line 9. -------------------------------------- ._ - ----- ------------------------------ I~ J --------------------- Remodeling --------- Remodeiin9 and/or repairing (describe) -- ---- � 1 -------------------------------------------------------'.- ----------------------------------------------------- 1. ------------------------------------------------------- --- j------------------ ----------------------------------------------------------------------------•---------------------•------------------------ -------- I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati9ps of the San Joaquin Local Health District. (Signed) J�i-l•-a�- t _ . ----------- ---- .(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). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - - ------------------- REVIEWED BY---------------------------------------------- ----- ---------------------------------=---------- ------ DATE - - BUILDING PERMIT ISSUED--------------i---- F - ---------- - --- --- -------- DATE Alterations and/or recommendations:---- ,`,„_,A= ,�•�.� � 1 ie --------------------------••----------------------••------- - - ------------------------ ----------------------- --- ----------- ----------------- -- -------------------------------------------------------------------- FINAL INSPECTION BY:- Date - ----------------------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cp. :,� i•F I:•; i