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1 FOROFFICE USE: 70' CP4,��» --------- --------- - � , APPLICATION FOR SANITATION PERMIT Permit No. �:. .. . k.. 4Complefe in Duplicate] 7 -!f S'„ Date issued- l 3 ---.. .1__ x;. _ This Permit i xhoires 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 . 549. JOB ADDRESS AND LOCATIO _________fi , ------- Owner ��___.__-__ f - -Owner's Name---- - --1_______ __ �_. h_ "' ------ 1:Z14f -------------------------- Phone--' 3uf AddressQ (.-. ---------•-- •------------------------ -- Contractor's Name yf - frl �--------•-------------------------•----- Phone--{. ��. Qy Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court [:1 Motel [] Other ❑ Number of livi4g units: __/.___ Number of bedrooms ___3_ Number of baths _ ._ Lot size ___e Water Supply: Public system [-Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil toLhepth of 3 feet: Sand [❑ Gravel 2k lSandy-Loam ❑ Clay Loam g-,-Clay ❑ Adobe❑ Hardpan ❑ i Previous Application Made: (If yes,date_�... #] No D'New Construction: Yes-`D QNo [ FHA VA: es 21"�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nea est!well_________________Distance from foundation------------------- Material------------------------------------------------- ElNo. of com arfinents--------------- -------Size-__------------ --Liquid depth----------------- .-----Capacity It Disposal ield: Distance from nearest well_________ _____Distance from foundafion. � Distance to nearest lot line_--,' Number of lines---------� �{_-_-__--Length of each line_---,;P,:5=!___.___._._.Width of trench._a ��________________ Type of filter material__- �` [ -Depth of filter ......Total length-------- _____________________ r Seepage Pit: Distance to nearest well______ A. -----__Distance fro foundation___�Q_.'_.Distance to nearest lot line__.4P-�.-- humberi�of pits------__-�----------l�mg material---- aterial__- Diameter---5--3 ------Depth----,�,-.r"�.----------_ 0 Cesspool: Distance from nearest wekl___I±1-"---------Distance from foundation--------------------Lining material--------__________..__.__----_____._. ❑ Size: Diameter--------------=--- g'} -------- Dept ----------Liquid Capacity-°-�---------------------gals, m Privy: Distance from nearest well__,.. ------_--------------y------------------Distance from nearest building _____________..__....-_- ❑ Distance to nearest lot line - --------------------------------------------------------------------- ---------- ---------------------------- g / descr�b 77 --- - ------------ Remodeling and/or re airing ( :_.._/-�7--` --_-- -- -- � 3 i -------------•----- ------- - � - > sP[�l_ lI---.-------------------------------------------------------- 1 ---------------------------------------------- -------------------------------------------------------- 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. , a _ (Signed)------------------------------� �------ ------------- wn ad/or Contractor) BY= —+------------------------------- -----------(Title)---------- --------- ------------- ------------------- (Plot plan, showing size of lot, location of systin relation to wells, buildings, etc., can be placed on. reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____-__________ _____--_ - 1 --- --------------------------------------------- -------------- DATE------�---� ------�--''---------------------------- BUILDING PERMIT ISSUED_'-------------------.------------------------------------------ ------ ------------------------------- DATE------------------------- -------------------------------- REVIEWED BY----------------- ----- ' =----------------------------------------- -�" _'�--------------------------------------------- DATE------------------------------ Alterations and/or recommendations: --- ---------------------------•--- ----------•------------------------- ------------- -------------- ----- �----------- - ; -� t- ---=---------- --------------------------------------------•--------------- ------------------------ ------ ----------------------------------------------- ------- ------ ---------i4�--------------- ------------------------------------------------------------ -------------------------- FINAL INSPECTION BY.-.!-...... -_. Date.-.-___7. -__lam ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH .DISTRICT ' 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.EO. f,