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FOR OFFICE USE: —J ;�4, _______________1 I� �d-� APPLICATION FOR SANITATION PERMIT Permit No..-.......__..._.._... -------------------------------------------- I ------------ (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. 549. t �. - JOB ADDRESS AND LOCATION---- ---- -- --- --_- __. X` Owner's Name---- , ------------------------------ Phone.-- _-----------•-----•---•--- Address - a. h, --------•--- Contractor's Name--------- `-----•--•--- Phone ---------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer . Court ❑ Motel ❑ Other ❑ / Number of living units:._,-__ Number of bedrooms Number of baths ._/___ Lot size _____wl-214-1__________________________________ Water Supply: Public system ❑ 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 ❑ Hardpan ❑ Previous Application Made: (If yes,date____.'__`__-------- ) No ❑ New Construction- Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Stic Tanl�: Distance from nearest well_________________ Distance from foundation -------------------- Material _______._______._____-_____---._._.._---_-____. No. of compartments ---------- --- - -----Size--------------------_------------Liquid depth ------------------------ -Capacity.....---------•-------- Disposal Field: Distance from nearest well_0l_-_..-.- Distance from foundafio ____/Q__ r" -_.Distance to nearest lot line___6........... Number of iines___t____�_______ _ Length of each line_____ ------------------ Width of trench --- A4 --- ________________________ Type of filter material___%.,& --Depth of filter material_rr/f`l---------- Total length --------- low :!______________________ Seepage Pit: Distance to nearest well -AW ----------- from fouPdation____,/f.------ Distance to nearest lot line --- r;'`_.r._-.___-_ ®/ Number of pits.__._ �______________ Lining material__�p _ ..Size: Diiimeter-�` �- p ,.�_ `�' �y-- --- De fh �--------------------- Cesspool: Distance from nearest well ----------------- Distance from foundation._.._._______. ----- Lining material ---- ._.------------------------------- ❑ Size: Diameter -------------------------------------- Dept h ------•------ --------------------------•-------- Liquid . Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest build ng__.--_-.__.__-__________________________. ❑ Distance to nearest lot line ----------------- -------------------------'------------------••-------••----- -- �7•--------------------------=•*�;------------------ .r Remodeling and/or repairing (describe):---------------------- ------------ ---'-• -------------------- .- . r ---------------••-•----•--•-----------•------------•-•-•------•---------------••-----------------------•-••-------------------------- Y ---------------- --- ----- :--------------- ------ ----- ------ - -- r . 7 I hereby certify that I have prepared this application and that the work will be done in accordance wifli San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. P41 -._---------- ------------------------------(Oor Contractor] (Signed)----------- r� Br..Y ~` trtlel ---------------------------------- (Plot plan, showing size of lot, location oftem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------777-_r�___-----------------------------------------------------•------------- DATE----- � �� REVIEWED BY ------------------------------------------------------------------------------------------------------------------------------ DATE---------------------_---- -------- - -•-----•--•-•------- BUILDINGPERMIT ISSUED---•------------------------------------------------------------------------------------------------- DATE ------------------------------------------------------------- Alterations and/or reya{nmendafions: ............._..__.___._._ __ _._ --------------4A=_ ---------------------•-•----------------._.----------------------•------------------ --- • ---- -----------------------------------------_..---- --------------------------•--•=-------,-----------------------------------:-------------------------------------------------- ----------------- ----------- --- ---- ¢� -------� �- � 11 (_ �is_-"1 s�-.--- - -xvCt-- --s�4L'"S�!11- �/�� ----------------'V..,Q .... FINAL INSPECTION BY:Y_ - - - Date-' =- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 well Oak Street _ 124. Sycamore- Street . Stockton, California Lodi, California a' 'Manteca, Caliioinfa' �� f ca -9 FEVI6E0 6.59 r.P.CG. 2M 6.60 205 West 9th Street Tracy, California