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FOR OFFICE USE: - �- ------- --------------------- _____________________________ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) i 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 complia a with County Ordinance No. 549. F-SC-1)L-OAJ JOB ADDRESS AND D Owner's Nameb ----------------- -------------- ------------ ----------- ----------- Phone---------- ------------------------ Address------------••-•---SITE.---- r� -------31r-L----------------JE , Contractor's Name--- -.------------------------------------------------------------------ ------- ------- --------------.- Phone------------------------------------ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_(---- Number of bedrooms _2----Plumber of baths J____ Lot size ---AC.RIFII&(� _--___________-____ Water Supply:- Pulalic system ❑ Community system [5 Private ❑ IJepth to Water Table �!_7t. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loa lay ElAdobe C] Hardpan Previous Application Made: (If yes,date----- --------) No UN---11ew Construction: Yes ❑ No 2---FHA/VA: Yes ❑ No [rem TYPE OF INSTALLATION AND SPECIFICATIONS: .��(No-sep+ic-tank-or-cesspool-permitted.�f�public-sewer-is_available,within 200 Senk: Distance from nearest well--- _-_Distance,from,foundation_--_./�--_-._,Ma C_ 9 ----------- 100 of compartments----------;;9=-_ _Size__X_ X57 __Liquid depth----- -------Capacity I Field: Distance from nearest well-.--,5--._.Distance from foundation.__l0 [ Distance to nearest lot line___J5.__ [ Number of lines__.-------! ___-__ . _- Length of each line---_-._- �q �� `z - - - --- - �?�_ - -� _.Width of trench---�y----------- ----------- N is s Type of filter material__}� CI ----_Depth of filter,material_---- f -__-.Total length--_________ �b_________ ,.a 1n Seepage-Pit: Distance to nearest well rJ_-----_Distance from foundation----/to--------gistance jo nearest lof line__.__ � . Number of pits_ ------------Lining material___ }S.__._.Size: Diameter-x__/.6-__._.Depth---f2_- ----- ^!a Cesspool: F—Distance from nearest;well__==--__-- Distance4r�om foundation.-------------------Lining material-_--_-_-_-_________________________ G meter.-- -- *4 De th ---------_Li uid Capacity gals. ❑ f t - - ?ti _._.., q p Y 9 Ok .� Privy: from nearest ------------------------ ----- from nearest building___._-_-_-----.----------------.-------.-. ❑ _ to nearest lot line - - - --------------- ----------Remodeling (describe__________________ r r t. .� . •�. ------------------- --------------------- -----------j-- ---�------------------------ - -- ----------------- -------- ------`-- ---- --------------------___---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St' a s, Ad milds an regula ions of the San Joaquin Local Health District. rk a . 0 (Signed)----=y-------------------��----- ----------------------------:----- ---------------------...--------------•---------------------------[Owner and/or Contractor] -I. _ ,. Iq ,.By:------ -=------------------•------- -_--:---- �_ �-[Title):: �-............_ - -r. ._... {plot plat+, showing size of lot, location of system in relation to wells, buildings, etc., Can be placed on reverse sideL'� i ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED4B --------!'R` ----=-------------------------------------- DATE---------j`I b . REVIEWED Bf-�--[------ !1' ----------------- [ +if - ------- DATE------ ---------- ----------------------------------------- BUILDING PERMIT ISSUED-- ----------------------------- ------------ ------------------------------------------------------ DATE-------------------------- - -------------------- -------• ---- Alterations and/or redommeidations:--------- ------------------------------------------- ----------------------•------------------•------••--------•------ -------------------- ------ La "" - F ____----------------------------- _._----------------_---------------------------------_---_---__-__-__-________.__--_______--_________________-_-__-_______--_____________---__-___-_______--.-_-_________-____-_ i r FINAL INSP - - - M _ Date '� r 6Xa` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California q Manteca,California Tracy,California F,P.CO. R tir