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FOR OFFICE USE: --------------------- ------ ------- APPLICATION FOR SANITATION PERMIT hermit Na. ... Qs. . --------- ------ ------------------ ------------------- (Complete in Duplicate) Date Issued .f�_/.. 6x _________________________________________________________ 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 CA ON. �) ---- ------ --- — -- Qti� Owner's Name------ C' -- Phone------------------------- p ; ------------- ....... 3�••_L-----" -'' ' j------••---------------------------------•-----------------------------------.---- Contractor's Name---- Installation ame--- _ .... = Phone. -�� - ---- lnstallation will serve: Residence [ji{parfmbnf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [� ILK Number of living units: ---. -.hlumber of bedrooms __ Number of baths -4- Lot size __/ - /1(___.�- _�D________________________ Water Supply: Public system (] Community system El Private ®Depth 40 to Water Table ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam��o ❑ ❑ Adobe ardpan ❑ Previous Application Made:*.(If yes,date......... . ..'.,']-'No-�NpWConstruction: Yes FNA/VA: Yes ❑ No TYPE OF iNSTALLATIOti XN`6 SPECIFICATIO 5: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-__------Distance from foundation d-.�-__.Material___ --5 ------- -No. of compartments_____________________Size__ ___ _._, C__Liquid depth____ ". __ Capacity�---�` -.--- r Disposal ield: Distance from nearest weli__,V_".........Distance from foundation./�-/--------Distance to nearest lot lin.5-^/---•-- I Number of lines------------ _____ ________Length of each line_.;45t__ -__9 Z) Width of trench."E] Y "10_-__-----_-------. Type-of filter-material-��l _ ' °z�` Depth of filter material-- ` -'/...__._Total length---- _ __!---------------------- be ________-__ / be ---------- 00 Seepa it: Distance to nearest well--- .._._Distance om foundation___ _ Distance to nearest lot Ie__,.�______ Number of pits___----------Lining material__�..__.__.Size: Diameter-__1.?.y...___ r Cesspool: Distance from nearest well-----------------Distance from foundation--------------..___.Lining material--------- __.------..._-------.---_- ❑ . �Size: Diameter--------------------- -_----------Depth--------------------- ------------------- ---------.Liquid Capacity----------------------------gals. � Priv _______________Distance from nearest bui{din �. Privy: e Distance from nearest well - --- - ----------- - - 9 ----------------------------- ----� ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelin and/or re airin describe :--..------- __t, --- �t ss --------------------------------------"--------------------------------------•-------------------------------------------------- ----------------------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify t_I have- repared this.application and that +he work will be done-in accordance with San Joaquin County ordinances, State laws, and r es a d regula ' s of the.-San Joaquin Local Health Distric+:, (Signed)------------------------------- ' : �'- -------------------------------------------------------------- ---- -----(Owner and/or Contractor) By:-------------------------------------------- L = (Title) C ------- . -- .........------ -- (Plot plan, showing size of lot, locat on system in relation to wefts,�ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ ° ---- ---------- ---------------------------------------- DATE-- /'Q-/` = ` ----- ---------------- - REVIEWEDBY----------------------------------------- - ------------- --=---- ------ DATE--- ------ -------------------------------------------------- BUILDING PERMIT ISSUED_------------------------------ -------- � ------ RATE ;f Alterations and/or recommendations:---/?. 67, ------------------- -------------------------------------__-_.._._-----. -_-,-_---_--_-__. -- ._ ___-__.-_-_---___.________ _ r ` _ - _____. ------------------------------- F- -------------- ---------------------------- ------------------------------ - -- - --------------- ----- L � kpl --- - ----- -------------------------- ---------------------------------------------------- ----------------- -------------------------------------------------------------------------=---------------------------------------------------------------------- FINAL INSPECTION B� ----- ' --------- ----------- - -- ---------- Date----- ------- -------- x. _• SAN JOAQUIN LOCAL HEALTH DISTRICT '1*01-E:Ha:ellon'Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.