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---- ---�� -�r------------ ------ v_-_._ APPLICATION FOR SANITATION PERMIT Permit No. .__..._. (Complete in Duplicate) --- -------------------- ------- -------- -------- --- This Permit Expires-1 Year From Date Issued Date Issued __r_- � 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 LOCATION- ______ _ / _ •-----------•----------- Owner's Name------------------ ----��----- ------------------------------------------- Phone_._ ---I? Contractor's Name_______ r iS4 P..4"4� -------------------------------------------------------•------•----------------- I j ---------------- Phone.. Installation will serve: Residence [i�/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: ---/__ Number of bedrooms I Number of baths _Z___ Lot size -----T,. X_f� """ Water Supply: Public system [Community system F1 Private F1 Depth to Water Table ---._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (] Clay Loam [��lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_-------------------) No New Construction., Yes ❑ No G7/�HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation--__.______-.______.Material- • --------- -------------- -- .. ❑ No. of compartmems--------------------------Size-------------------- ------Liquid depth__. ---------- --------- ------Capacity ------ Disposal Field: Distance from nearest well_________________Distance from foundation-------------------"Distance to nearest lot line___--"____-______ ❑ Number of lines--I--------------------------------Length of each line--------_--------------------.Width of trench.---------""" Type of filter material-__________- -------------------- -� ------------Depth of fitter material-----------------------Total length-----------------:-------- Seepage it: Distance to nearest well_- ------Distance from foundation_ / 6 (�--__-._-_ Distance to nearest lot line___ r� Number of pits..A/--------------Lining materiaL+WV,,etj -SIZE; Diameter____ Cesspool: Distance from nearest well_________________Distance from foundation_____.._-__-___--. 1 I .Lining material---------------------- ---- ---------- =---------------•. ❑ Size: Diameter----- -------------------- ------ ---Depth--------------- ------ ----------Liquid Capacity ----:-•-gal Privy: Distance from nearest-well ________________--------------------------------Distance from nearest buildin9Q ------------------ ------- ❑ Distance to nearest lot fine --------------------- ------ - epairing (describe : 76p 1 ' G. _Ti _ ---�------ - -.tet`'-i��---------------------- Remodeling and/or r � - -------------------------------------------------- ------------------- P ----------------PP-------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have rep ti.red this application-and that the work will be done in accordance with San Joaquin County ordinances, State laws,�ales and `regulations of the San Joaquin Local Health District. (Signed)------------------------- 1 � -- ----- ------------------------- ----------- r - BYc___""----"""""-• "•• � '�`�`�-- -- (Title)---,,-.- /wran or Contractor) -- ---------- --- - ----- -- __ __ ----- (Plot plan, showing st of lot, locati iiof system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE O ---------------- NLY APPLICATION ACCEPTED BY____._REVIEWED BY _ - ------------------------------------- DATE---------- ------- y 3QG - - --------------------------------------- -------------------------- DATE------ ----------- ------------------------------------------ I - BUILDING PERMIT ISSUED-------------------}-- Z. DATE --------------------------------------------------- Alterations and/or recommendations:_____ --------- --- Sm. --••------------ -- ------------------ ---------- --- I --------------------------------------- ------------------- --------- ------ FINAL INSPECTION BY---- - - -- ---------------- Date vD S - -------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT + 1601 E.Haxelion Ave,. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co. - r -