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y�FOROFFICE USE: =�.2 �_._ ----- ----------- ~ y~ APPLICATION FOR SANITATION PERMIT Permit No. . _-_-----_ ----------------- - ------- --- ---- ----------------- (Complefe in Duplicate) Qate Issued __]z_�_�/._S-/ -- ------------------ ---------------------------------- This Permit Expires 1 Year From Date Issued 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 49. JOB ADDRESS AND�L/OCATION___ _ 141. _ ---------------------------------- ----- - ----------------------------------------------------- Owner's Name-------•TJ'`-/ Address...........................•------- � 1 ` Contractor's Name-- ------ --- ----- _ .__ ._f� _._S�r7�" _--_-- �a _^r �C.f--------------- ---- Phone.------- Installation will serve: Residence PT'�Apartment House ❑ Commercial ❑ Trailer Court 1-1Motel ElOther ❑ Number of living units: _1____ Number of bedrooms_ Number off baths __��_ t size ___--7. 4AL-Ct — Water Supply: Public system C] Community system El Private Depth to Water Table a-LAt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan_0 w; Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No [P-' HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Tank: Distance from nearest well-----------------Distance from foundation------------------- Material-----_-____.-__._--_____...._____---.-.___..____- No. of compartments------------- - ----------Size---------------------- ---------Liquid d pth--------------------------Capacity----------------------- gr D• sal Distance from near gst well..�j_p_._Distance from foundation_____ __,L1____.Qa#ante to nearest lot line------/C Number of lines----- ___Len Length of each line__ P Width of trench_��--------_---____ gr -- .��} Type of filter materia .. Depth of filter material------� `�----Total length_____________________ __�_._ f� See a e Pit: Distance to Weare t well_ Distant from foundation----p /, .-__ __. `f 40__-_.Qistance to nearest lot line___,._- �. Number of pits...----------------Lining material�0_ 1fo__undafior.__.. __._.Size: Di meter_.�.f A._.__.Depth_...��__�'TO_-___-_-____.__ e1 Cesspool: Distance from nearest well_________________Distance fro ____.______..Lining material--------- ._____.__.__ ❑ Size: Diameter-------------------------------------Depth-------------------------------- - -----------------Liquid Capacity-.--------------------------gals. Z Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building--.._..._____---_----________.._____--- ❑ Distance to nearest lot line -------------------------------------------------------- -------------------------------------------------------------- /d Remodeling and/or repairing (describe):--- . Jc ----------------------------------- ---------------------------- -------------- -- ---- -------- ------ --------- --------------------------------------------- - ----------------------------- ._.._--- --- - ------------- ------------ --------------------------- --------•-------------------•- ------- -----------------------------------•------------------------ ------------- - ------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , nd rules and regul tions of he San Joaquin Loc alth District. (Signed)._�CL.%LC.�.._ _-1�..__ y� _- `_../_-'.z/ .,04.v. pG� f_ _ ._ n or Contractor) By:------------------------------------- --------------Title -------------------.-------- ----- - (Plot plan, showing size of lot, location of system in rel on to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------ DATE_----------- ---- -? �, REVIEWEDBY---------------------------- - - -- ------------------------------------------------------------------------------ DATE----------- - -- -- - - - BUILDING PERMIT ISSUED---------------------------------------- / DATE------------------------------------------------- Alterations end/or recommendations:. l'---�s1---_- _��11F fa------------------------------------------------------------------------------- -------------------------------------------------------------------------- - - ----------------------------------------------------------------------------------•---- ------- ----------------------------------•---------- ---- ----------------------------------------- --------------------------1---------------------------------------------------------------------------------------------------------------- ---- ---- ---------------- FINAL INSPECTION BY:............�?f - ---- Date - ---- -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cq.