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i ------------------ ----------------------------- _. `--.-------._ -----------------.----------.--------- AF•%,,.,CATION FOR SANITATION PERM,,,/ Permit No. 2c . ------- (Complete in Duplicate) I ----------------------- - --- --------- / --------------------- This Permit Expires 1 Year From Date Issued � Date Issued is. 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 AN/D - -- r y� ------- r Owner's Namg.------J rr------UF-- - `- - --------------------------------------------------------._ Phone..... ----------------`-----`-- Address----- t �� -.Q. -- '- ' -- ------- ... r Contractor's Name_--- -------- �- ---- ---- - --- - ------ "-- - Phone..------•..... - --- - -- ---- - ------------ --------•---------- Installation will serve: Residence Eff, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: --�---- Number of bedrooms -- 1--. Number of baths ---)'--- Lot size --- -------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Wafer Table ------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan r Previous Application Made: (If yes,date I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-------.---------Distance from foundation.......-------------Material ___-_-__-_- _--..-..-_.__-___-__-._.-_.❑ No. of compartments.. .-----..-Size-....--------------------------Liquid depth-------------------------Capacity-------_............. Dispos geld: Distance from nearest well--_-s4_.....Distance from foundation__---lll_'-----Distance to nearest lot�line___s-- r [/ Number of lines------_.._._ Length of each line_-______L_00_.__ ____.Width of trench-----7--_----------.------------ Type of filter material__--__ ^!---- ---Depth of filter material-----/_q_r------._Total length--------- _6Q:'_____.-............ _ d See pa Pit: Distance to nearest well.-----i__Q-4._f__-.Distance from foundation-_1_b__e-------Distance to nearest lot line..._ .......y.... GI t. Number of pits---------I_.---------Lining material.------&i2- __Size: Diameter_-___-) ?..........Depth----- -------- Cesspool: Distance from nearest well---------------Distance from foundation--------------------Lining material..--------- -.__-____--_-_-_.------ d ❑ Size: Diameter-------------'------------------------Depth------------------------------------ -----------Liquid Capacity.-------------------------gals. r Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building----------._...__-------__--__-_. ❑ Distance to nearest lot line----- ----------------------------------------------'-------'------------------------------------------------------------------------- rRemodeling and/or repairing (describe):------------ ------------------ -------------`------------------------------- --------------------------_-------------------- -----------------.......—..__.---___.__._._..__._..____---____._.___----_--_---------—_______.______--_--__________..__-___._..__...._._...-__.._.-_.-_--_.._._..._......_.._—_____.-..........._-__ -------------------------------- ------------------------------------__._.__-___.___.._.___._--___-_-._-__._-..._._..___.._-____-___-.___._.—_-..-_—_.___._--_______-__.-_-__.__._____._.._______.._-____-.--_---_.__--__ 1 hereby certify that I have prepared this application and that the work will be done in accordance with $an Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. (Signed)........ ........_---__-_-.._- -___-_____ - - - - - . - cler and/or Contractor) e '- - Isle Y° ----------- - --dT ---------------------------------- - ------- (Plot plan, showing size of lot, location o sv f;e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYy APPLICATION ACCEPTED BY- - ----- ' --------- --------------------------------------------------------- DATE-- .---1--e ------------------ - rREVIEWED BY--------------------------------------------------------------'--------------------------------------------------- DATE------------ - - - -------- ------ BUILDING PERMIT ISSUED------------_--- ----------.---------------------------------------------------- DATE- ------- --------------------------- ----- -------------------------- Alterations and/or recommendations------------------------------------------------`--------------------------------------_............--.._.:----------------------------------------- hs. --------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------------- J FINAL INSPECTION BY: s:j -� 3 -as ' :------------- - Date---- . � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 Wesl 9th Street Stockton, California Lodi,Callfarnia Manteca,California Tracy,California Is.