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FOR FFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __l._.___.__-_•______. (Complete in Duplicate) _ 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. 54 JOB ADDRESS AND LOCA-51ON -- ------- --- ----- --- -- � - - ! ------------------------------------------------------------------- Owner's Name-------- . ----- - ------- ---�� --- - -- ----- - - - ----------- --------------------- Phone---------._------------------------ Address-------------------------•-- ----__.... -. -------- .G` --c— T-_ Contractor's Name------- e'"' Phone... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑�a D k l Number of living units: __.�__._ N er of bedrooms _-__ Nu` mber of baths(---__-- Lot size ------------_____________________________________________-_ Water Supply: Public system Community system ❑ Private [] Depth to Water Table _4�/7ft. ` —Character of soil to a depth of 3 feet: Sand ElGravel ❑ Sand oam ❑ Clay Loam El El Adobe Hardpan ❑ ) Previous Application Made: {If yes,date--------------------f No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - n k `(No septic tank or cesspool'permitted if public sewer is available within 200 feet.). Septic T Distance from nearest well-_-." ^Distance from foundation__ r/ G � - `.Mater al -------- ------ ��-------- /r .___Liquid depth:'_ !✓� P Y No. of compartments-.-____ _.-._ Size___._ V 1i a actt ____.___ Disposal Field: Distance from nearest w IL_ ...-..____- istance from foundation------ to nearest lot line____-____- , Number of lines------------------ ______Length of each lire--_-__ __-_ -_.Width of trench--e Type of filter'material-__�_%. epth of filter material-__-//�Z_ __-.Total length---_-_-- l__________________ vo Seepa Pit: Distance to nearest Weil istance f fo ndation__/__A__�-_!Distance to nearest lot line.-_�_ O Number P - -, --.-. -Linin Size:-.Diameter r 1 Humber of- its---'-----: -_-._t_ g•'material__��- _ .-. ::.: �n r Cesspool: Distance from nearest well-----------------Distance from foundation--------------____..Lining material--_-______-_---_-__-________- ---__. V' ❑ Size: Diameter------------------------------ ------Depth---------------- --------------------- ------ ----Liquid Capacity-=----------- --------------gals. Privy: Distance from nearest well------------------- ----------------- ---- Distance- from nearest building ❑ Distance to nearest lot line------------------------------- --------------- ----------------------- --`-----1'--- ------------------- Remod an /or re airing esc be} -- - --- -- - - - -------------------------------------------------------------- ---------------- --- e ---------- --- ------------------------------------------- r I hereby certify that I have Erepaired this application and'#hat the work will be done in.accordance.with San Joaquin County ordinances, State laws, and r s a d regulation ee San oaquin Local Health'District. ------- (Signed) ----- --------- --------------------f ----------- {Owner and/or Contractor) --------------------------- - -- -- ---------------------- $y:. - ---------------- [Title) (Plot plan, showing size of lot, location o s em in relation to wells, buildings, etc_, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - - - - ---------------------------------------------- DATE L �; REVIEWEDBY-------- '----------- --------- --------------------------- ---------------------------------- DATE------------------------------------------------------------ BUILDINGP MIT ISSUED-------------------------- --------------------------------------I---------------- DATE------------------------------------------------------------- Alteration /Pr o men a ' ns:-_--_ - --- ------ - --------- -- ----------------------------------------------------- --------- -- - ----------------�--�- ---- -- Qom: = { �u �_ -,fir y , � F" 1 --------------------------------------------------- ----------- ---------------------------- ---- ------------------------ --- - ---_-__- ------_-_ _ - FINAL INSPECTION BY:-------- -- C<1 ------------- - -------- Date------- � "2J ' lj -------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton.Ave, i a 300 West Oak Street E 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California .Manteca,ealifornia� Tracy, California