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FOR OFFICE USE: T eT_ 1 ----------------------- ---------- -.. !Y�.. y APPLICATION FOR SANITATION PERMIT Permit No. _. -------- -- --------------------------------------------- (Complete in Duplicate) 411ti 2 --- This Permit Ex ices 1 Year From Date Issued Date issued ......Vit...(6 S.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and in 11 the work herein described. This application is made in compliance with County ina No. 549. JOB ADDRESS AND CATI N. - ±�-_- Q-�__- •____ /�-- - ------/----- Owner's Name--------- txU.i--.__.-- . Ph no Z �.r 771/2. 76Z ----- Address------ �. Contractor's Name --- -- ------ ---- ---- ----- ------ ---- Phone -----_ Installation will serve: Residence partment House ] Commercial ❑ railer Court ❑®Motel ❑ Other ❑ Number of living units:I'Number of bedrooms _3.. Number of baths -7 Lot.size ..�-. .�------ --------- T`� Water Supply: Public system �mmunity system ❑ Private E] Depth to Water Table W1ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ _Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: (If yes,date..x----------------) No ❑ New Construction: Yes ❑ No �HANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic p tank or cesspool permitted if public sewer is available within 200 feet.) S &ic� Distance from nearest well-----------------Distance from foundation----------------___Material------------------.------------------------------ No. of compartments---l------------- -------Size- ------------------------------Liquid.depth--------------- - ------..Capacity - D' sVP : Distance from nearg st we€. . NA4,.r_.-Distance from foundation---/-.......Distance to nearest 411 ,e_.' .-Number of lines.-_l---- .. �f Length of each line_ -Q-__r----....�-.Width of trench..._. --------------- ++d Type of filter materi - _ Q.IC 'bepth of filter m real-..... -'_._�otal length--- .------------------------ 4, e i Distance to neargst weli_ .. ,_Distance rom fpundafion-_------ . ..Dista ce to nearest to line_-.�_---- W n Number of pits-_!............._.--Lining material__1<_q0 f' .---Size: Diameter�6. r...Depth______ �.........__. f? - v Cesspool: Distance from nearest well.................Distance from fo ndation....----------------Lining material.._.___...._._...............__-___. ❑ Size: Diameter--------------------------------------Depth------------------------------------ ---------------Liquid Capacity--------------------------.-gals. %in r Privy: Distance from nearest well------------------------------- '------_-Distance from nearesf building---_----------------------------- ❑ Distance to nearest lot line-- --- ---------------------------------------------------------------- ----------------- a � Remodeling and/or repairing (describe • -h ---------------- --•--------•-------------------- ------------------ ------- ---- -- --- ---- �r 4 --------------------------------------- ------------ ------ - - - - - --- --- ----- �- I hereby certify that I have prepared this application an that the rk will be do a in accordance with San Joaquin County ordinances, e I "a ules a regulations of the Sa Joaquin L I Health Di' ict.; (Si ne .. i 9 - - -- �'- ---- - - ---- ---- --- /�-t '� r Contractor) l By:-------------------- i-_ •_-------...-.-------------------------------------------------- -------------- --- ---- ---- -------- itle)----�- ----------------------------------- -- (Plot plan, showing size of lot, location of system in relation'f wells, buildings, c., can be placed on reverse side). a r 1 I FOR DEPARTMENT USE ONLY r' APPLICATION ACCEPTED BY_------ -- --- -- -------------- ------ ---------------- ----------------------- DATE--- - 2 REVIEWEDBY ------------------------- ----- - ------------------- ------------- --------------------------------------------- DATE----- ------------------------------------------------------ BUILDINGPERMIT ISSUED---- _------------------------------------------------------------------------------------------------ DATE------------------------------------------- I Alterations and/or recommen' ations:::.-------------------------------- 41 ---- --------- ------- - 1P--------------------------------------------- ---------------------- - ----------------- I r .......................................................................... -------------------------.----------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------- I FINAL INSPECTION BY:-------- ----------- - --.---.---- Date----- `. _-'4S- ---- -- --------------------------------- V SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street # Y 205 West 9th Street ' I Stockton,California Lodi,California Manteca,California Tracy,California 8 F.P.0 O. � c