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FOR OFFICE /USE: ------------------- =------------- ----------- ------- � ..•________ APPLICATION FOR SANITATION PERMIT Permit No. __ ,.7�.. . �3 b`r, 3-----B;-- -0-- (Complete in Duplicate) r� ..Z` _ a --------------------- --- 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 LOCATIC�N1;0 _04�Name-----... _ ---•-- --- Phone.................------------- 00 Address........ "'/r ---------•----------------------------------------------------------.............................................. Name------------------- = ----•-----------------......---------••---•--------------------------•----- Phone................................... Installation will serve: Residence gg"Afpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__ Number of bedrooms V2.-*- Number of baths _/__ Lot size+ . ----/_'_ ............................... i Water Supply: Public system W_�Otommunity system ❑ Private ❑ Depth To Water Table /494. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er"gardpan ❑ Previous Application Made: 11f yes,date--------------------} No 04-1 New Construction: Yes jQo-Mo ❑ FHA/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--- -------Dizstsom fou�ndation_.....0�-----matt�al-- _ ________[� No. of compartments-.-----.r _____________Sieap Liquid depth___ � Ica p-aci.tyf.6 -... Disposal Field: Distance from nearest well----"' _---Distance from foundati /0-......Distance to nearest lot line.-! �_-____. Number of lines........ Y--�_ -_.__ Length of each line---- &-!-f�-.--..Width of frenth-�` ------------------------ de Type of filter material.��1_�epth of filter material...��--_---__. Total len th__�Fy-� _________________�!.#,--.- i r g � Seepage Pit: Distance to nearest well--------!�"'C-- Distance from foun tion----1��.._-_.Distance to nearest lot lines [ Number of pits..../-------------Lining material-_ .qtr ize: Diameter_..-_------Depth-1-2.0f--*-------- --------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material----...-----.----.------_-_- Size: Diameter-------------------------------- -------------------------------- Liquid Capacity----------------------------gals. ❑ -----Depth------------ -- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------_--------------- Distance --..-_-----------_.Distance to nearest lot line- - ----------------`--'---/------- --------------•---------------•----- --•-----------------------•-------------------- Remodeling and/or repairing (describe=------------------ ?�'s`�' --------------------------------•-•-----------------------------------------------------------------------------------------------------------------------------------------••------••----••-•--------------•----•------------ ------------•-•-------•------•-•---------------------•----•---------------------------------------•---------------------------------------------•--------------------------------------•-•--------------------------•-------- 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. I (Signed)--------- ---- ----- -------------------- - •---- --- ---------------- -----------( or Contractor) n (Plot BY:------------------------•-------------------------------- •---- •------ {Title).... lot plan, showing size of lot, location of system in r a ' n to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_.--t/,-------- -= ------------------------------------------------ DATE------C_<r-_A �� REVIEWEDBY--------------------------------------------- -----------=-------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------;--- _ __---- - DATE ----- _ Alferations and/or recommendations:--_ r,l.------ ��- - 1 .- —_ --�-•------------... -•------------------•----------•-•------------------------------...._.-..----- --------------- -------------------------------- ------------------•----.....--------------•----------••--•------------------------- --------------------------------------------------------------•-•--•........------------------------------..--........................ ---------------------------------------- ------------------------------- ------ --------- FINAL INSPECTION B Date-- SAN J AQUIN OCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS