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FOR OFFICE USE: � _. S Permit No. Ai� . APPLICATION FOIL`SANITATION PERMIT y, (Complete in Duplicate) bate Issued ___---+- ---F�-7 ------------------------- ----- -------------------------- � 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 LOCCATION _�_l_____ �Z ------- � ------------ - ,------- one ---------�-f-�---=- Owners Name -------------- ----------- ----- :---:-.----------------- - ¢ Address------------------- - -- ----- T1 -------------------------------------------------------------- S ` Q t -- � �--" Phone,- Contractor's Name----- -- L -- -- ---------- Installation • will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: ---r.2__ Number of bedrooms , ___.Number of baths __ "-- Lot size __ � U-_ --1• Cla-------------------- a Wet& Supply: Public system ,[Community system El Private ❑ -Depth to Water Table ft.. Character of soil to a depth of 3 feet: Sand F1 'Gravel E] —Gt Sandy Loam ❑ Clay Loam [] lay 05 E]Adobe 'Hardpan❑" Previous Application Made: (if yes,date....................} No 2----New Construction: Yes ElNo FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from ne1 arest well________________Distance from foundation____________________Material___.________...______.___________________..--__. ❑ No. of compartments-------------- -----Size-------------------------------Liquid depth Capacity 5 IX% Disposal Field: Distance from nearest well..------ from foundation___.�? _ ! istance to nearest lot line ________ oov 95- Number of lines____________ ___ -._.Length of each -----------------Width of trench- �--------=:-- Type of filter material-_____- -.,C��_ _De th of filter material-__I,�____._ / . ._Total length------��---=---------•- ----------- , Seepage Pit: Distance to nearest well----------------------Distance Pram foundation_r -------4�istance to nearest lot line____ _..____] Number of pits__'______I_..-...--Lining materiaL_3/'� G _Size: Diameter__ '�_____.Depth__.. ------------------ 1� f.t Cesspool: Distance from nearest well______ 45 _____-_-_-bistance from foundation_-.._-.___.__ ___.Lining material___________________._____.._______.. tj I] Size: Diameter_-] -----------Depth-------------- ---- ---------------- - -------------Liquid Capacity----------- ----------------gals. _X7- r, - j Privy: Distance from nearest well-------------- ---------------------------- -----Distance from nearest building.---------.------ ------------------------ Distance to nearest lot line---------------------- ----- -- Remodeling and/or repairing•(describe): ____._',ls:`!I!I____.___-_ - w:- ----- -----------------------------------------------------------•-------------------------- _ --------------------------------------------------------------------------------------------------------- I hereby certify that I have pr`e'pared this application and that the work will be done in accordance with San Joaquin County l ordinances. State laws, a ales and regulations of the San Joaquin Local Health District. !' 1 -1- I er d or Contractor (Signed - ��/• ti ... `� ��Y—' - -------------- -------------- - - ----------------- --------- -------- --------(Title)----- -------------------------------------------- By:i (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). ! I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- - --------- ,5--------------------------- DATE------ ------- -- ----------------------- - REVIEWED BY DATE------------- =------------------ r ---------- ------------------------------ -----; ------------------------ BUILDINGPERMIT`ISSUED---------•--------------=------------------ ------------------------------------- DATE---------- ------------- ------------------- i r - ..---_ . ---•------------- Alterations an or rec mmendatibns:___---------- ------------------------•----------------------------------------------' a. - G/ _ z-------;---= -----------------•------------------------------ -------- --------------------------------------------------------------------- ---- ------------------ ----------- FINAL INSPECTION BY:------- -�- ----------------------- -- Date r! -~�------- ----'------ ---- --------------- --------------- ` r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i Lodi,California Manteca,California Tracy,California F.P.CO.