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FOR OFFICE U �-1 ------------- -/. ---- APPLICATION FOR SANITATION PERMIT(2— Permit No. , -....=..... -------------- ------------------------------ (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. JOB ADDRESS AND LOCATION----_---!?19Y----L---- -d--T{=------- _�� Owner's Name------------- ------ 0 - -------_--------------------------------- ------ Phone---!V(`-3--`--7-1AJ----- Address------- •-----•------•-----------------------------------------------------------------------------------------------------• --------------- Contractor's Name � c'.. JJ s ? J------------- ------- Phone.. l_ Installation will serve: Residence [j' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L... Number of bedrooms J._._ Number of baths ._.. Lot size ....1--0-l X._ 5—d Water Supply: Public system Rj— 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 [a Hardpan ❑ Previous Application Made: (If yes,date... ----41--------) No E- New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No 0- 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-N-5?--------Distance from foundation----/.v.._r.......Material----- _ ... .4-c-�C----------------- -- No. of compartments-.-----4.......... X- Liquid depth-------- .`-----------Capacity---AK-° Disposal Field: Distance from nearest well...A16-------Distance from foundation---/.............Distance to nearest lot line----$ Number of lines--------�7-----------------------Length of each lire------ Width of trench.--_.--;�_,---------------------- Type --_.__.__----_____--Type of filter material:-----�'?�__cA-----Depth of filter material----. length-_--_-_dS=q_________________________ r Seepage Pit: Distance to nearest well__, ----------Distance from foundation____!_ _______.Distance to nearest lot line. 00 ------------..- 07 Number of pits------Z-------.----Lining material----- Size: Diameter-.---3}.e'e--.-.-.Depth------.L 3�-'-------_---- Cesspool: Distance from nearest well---- -- --Distance from foundation.-------------------Lining material__.____---.-__-____________-__--_--. ❑ Size: Diameter--------------------------------------Depth----------------------------- - --- ----------------Liquid Capacity. ------------------ ----gals. Privy: from nearest weh-----__---------------- -----------------------Distance from nearest building----------------------------------------- ❑ Distance to Weare i�1 ine______________ ----------------------------------------------------------------------------------------------------------------- ---- 0 Remodeling and/or repairing {describe)------------------ - --------------------------- ----------------------------------------•---------------------------•------------------•------------- --•------------------------------- ------------------------------------- --------------------------------- --------------------- ------------------------------------------------------------------------------------- ------------------------------ 1 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) `'- ', -----------------------------------------------------------------------(Owner and/or Contractor) Y By:-------------------- ------------------------------------------------------------ -------------(Title)---------------- -----.-------------- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- � -�---------------------------------------------------------------- DATE. ---------- ---------------- REVIEWEDBY--------------------------------- --------------------------------------------------------- DATE.------- --------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------- ----------_----------------- ---- -------------- DATE----------------------- --------------- _ Alterations and/or recommendations:.___5..�_ .�..I�.` _._-.+.ISt._.---t S -------------------- �C%. �� -------ZrS---- ----------------- ------------------------------------------------------------------------------------------------------------ ------ ------ --------------• -----------------------------------------t' 1 -1----------------------------------------- --- ------------------------ ------ ---------------------------------------------------------- ------------- - ---------- ---------- --------- -------------------------------- FINAL INSPECTION BY:.------ S------------------ -------------- Date---- - ------------------------- SAN ----- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Avt. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 R.