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FOR OFFICE USE: -/5-: �1 ---- -- Permit No. . fJ. c �. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ------------------- - ------------------- - _ . -._._- This Permit Expires 1 Year From Date issue Applicat__ _ - -- _ _____ -_.ion 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_ 1),zP_ ---------- Owner's ------ -------------------------------------------- ---------------------------------------------- -------------------------------------------------- -----------------------------•------- Address fPhone----------------- ---------------- Contractor's Name--i— - -------------------------------- Installation will serve: Residence 16—Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths J--- Lot size ...10-7,43-d--0-------------------- Number of living units: --- Number of bedrooms :;� - - � Water Supply: Public system (Community system ❑ Private ❑ Depth to Water Table _!t'_ tt• Character of sail to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam'El ` Clay L] Adobe,;�Hardpan El Previous Application Made: (If yes,date- No [A---New Construction: Yes M__9_0 El ; FHA/VA: Yes ®— No F1TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet` Septic Tank: Distance from nearest well.7=-------_Distance from foundation lr♦'_...---_...MatefiaL..- .0 y r------------- ------------ _ Liquid depth = Capacity.---- 04- No.-of compartments -------------------Size----- --__ -; -- - Disposal Field: Distance from nearest well.-.- --__Distance from foundation./#----..-._...-Distance to nearest lot line s?------.---- Len Length of each line.._: ---------- Type -- ---------.Width of trench..sr - ---------------------- 1 � �C - -----.Total length is ------ NumbEr o Ines............._. T e of filter n aro stlwlelLA�G__-_- ..D stance frotmrfoundation-g g f A I yp p r _/___.._.._.Distance to nearest lot iine__.1�.._ -- � Seepage Pit: Distance I "' 0 �-,�.. --!.Depth th_.-- 2. r5----------------- � Number of pits....f-_..............Lining mater:al.`_��f.��----Size Diameter_ - d p Cesspool: —Distance-from nearest well-_------_-----_Distance from foundation....................Lining material------------------ .-_.--------•-els. ❑ from nearest well: �o ---Distance f rnLiquid Capacity --------g Size: Diameter------------- -------------------------De th---------------I--------------------------------- ---_tom nearest building--.-.------------------------------------ Privy: ---------- ------------ ---------- Privy: Distance F I s. Distance to nearest lot line---'------------------------ -- o ---------=------------ --- ------------------------------------------------- : Remodeling and/or repairing {dcscribe)------------------------:------------- --------------- ----------------- i----j-------—------------------------ ------------------------------------------------------------------------------ - s - ------ ------------------------------------------ - -----------------------!-------------------------- -!�==--------------=---------------------------------------------- ----------------------------- --- 1 hereby certify t 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ! a rules and regulations of the San Joaquin Local'Health District. e (Signed)---------- L --------------------- ----------------------------------- ------- ---....(Owner and/or Contractor Title (Plot plan, showing sized f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- DATE. T�"� = � : ------- 0 REVIEWED BY------------------------------------ --- -- ---- - -- ------ --------------------------------------- - DATE ------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED----------------- --------------------------------------------------------------- i Alterations and/or recom endatons:----; - - r ............... --- ------ -------------------------------------------•-------------------------- .10 .----------- y - --------------------------------•------- --------- -------------------------- Y - ------------------------------------ - a ----------- Date------- -- r' ------------------------------------- FINAL INSPECTION BY------- --- - -- -- "� S N J QUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.