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rl.JKUrrlLt uJt: —� .r --------------------------------------------------------- - -------------------------------------------- ..... APPLICATION FOR SANITATION PERMIT Pdrmit No. --------------------------------- ------- ----- --------- (Com' lets hrDuplicate) --------- ----------- -- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION._�5. �0______ CC�lU_SD�'i&v K M - ----------------- ------------------------------------------------- Owner's Name-------------------•-I`�MIZj, - -3 /� l I2N�r-�----•-- ------- •------------------ ----- Address --�--Z--�- � `f 1-±171 ---s----tl ) 5-Tt7 �� Phone. Contractor's Name---------------- hS �i:-------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/.- Number of bedrooms -"� - Number of baths --Q-_ Lot size _-�D X__l {D-----__.•-----------_ ` Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft- Character of soil to a depth of 3 feet. Sand 0 Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date------_------------) NoZ�--New Construction: Yes Eh—No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: RN (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,&0(7-_Distance fro , foundation_-& ----_---.Ma e ial----__---(�G-*.-'71 ___________ (� No. of compartments------ Q-------- Size-IQ X-4'1�------------Liquid depth---q��-------- Capacity- _Z� Disposal Field: Distance from nearest well_/-D0]._Distance from foundation- S ---_--_-Distance to nearest loc�in%.-- - _-_.. Number of lines--------------- --------- ---- Length of each line---- �'P ---..Width of trench.----- Type of filter ml_ateriacDepth of filter material-------P .-___..-Total length---------��-�?--------------------- Seepage Pit: Distance to nearest well------ ---------------Distance from foundation------------------- Distance to nearest lot line------..--.---_-- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------_--_----_------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material----._------- Size: Diameter----------- ------------------------- Depth----------------------------------------------------Liquid Capacity--- ---------- gals. Privy: Distance from nearest well------- -------------------_------_. -------.-.-Distance from nearest building ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------- -__-__-__------_- - - -- - - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ---- * -tom ------------------------- --------(Owner and/or Contractor) ep - ----- ------------------------------- BY4 - cry+ - ------ v --�--- ¢-------------------------------------------------------(Title)------------- (Plot plan, showing size of lot, location of s e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ti APPLICATION ACCEPTED 13 -�'-'L-- -- ---------------- ------ DATE-- - �� ---------------- ED BY-------------- ------ ------------- ------------------------------------------------------------- --- DATE ----------------------- ------------- BUILDING PERMIT ISSU -------- ---------------------------------------------------- ------ -------------------------------- DATE -- ------------- Aterations and/or reco ations:------------------------------------- -------------------- ---------------------- ----------------------------------------------------------------•------------------------------------------------- --------- ---------------------- ------------------------------------------------------------------------------•----------------------------------------------------------------- - ------------------------------------------------------------------- FINAL fN5PECTION B -- -- ------------- ----- ----- ------------------------ -.-----. - - -------- Date----- S S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California