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FOR OFFICE USE:.. _ �� Permit No. -- ---" ---.y_ _[ " APPLICATION FOR SANITATION PERMIT �} &S ;Parmit ------------ Q /(Complete in Duplicate) Date`-- -- Expires 1 Year From Date Issued ' �. Applica ion "s �1�'re y made o`fhe San Joaquin Local Health District for a permit to construct and install the work herein described. PP This application is made in compliance with County Ordinance No. 549. DRESS AND LO ATION_ = ------------� --- Z JOB AD + .P � � - ----- Phone._ 6` Name---------- ` - -------------- Owner's -•-••------- r Address------------- Contractor's Name----------------- -------- ----- - ----------- I Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Traiiller Court ❑ Motel ❑ Other El Number of living units: _ __.-- Number of bedrooms __�mber of baths I `Private ❑ __ Depth to Water Table ft. Water Supply: Public system E] Community system ❑ 6 � ❑ y ❑ Ad Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy,Loam.❑ Clay Loam Cla Adobe ❑ Hardpan Previous Application Made: . (lf yes,date-------- -----------1 No j� New".Construction: Yes,[] No � A/Va: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:)_ I ss nce from foundation_.---Material---------------------------------------- -------- Septic Tank:'' Distance from nearest well__. � Li uid de th._.__---_---------------Capacity-_--_------_----__..-_ e No. of compartments_ .-----Size"--------------------- 9 P• � � - � � L'-__.Distance to nearest lot lire...--'-�-�. Disposal Field: Distance fro m'iiearest well-�0 ._Distance from foundation.__.-- __._� / j Number of lines_--------_"---- -- --------------Length of each line---------��---Q- �9 Width of trench--_.__- ------------- W -� ' � • �J �_ e th of filter material__.. Total' length____. "-�---•---- ------- -------- � Type,of filter'mater,al�5/,_ lC-� P l Seepage it: Distancetto,nearest well_ _' /.--.Distance from foundation-_-. _� ---..Distan--j to nearest lot link.- Number of pits__--._�_-._-_"---Lining material.--/._,o._ z Size: Diameter--- ---------Depth---- -a -------' . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linung Cat act gals. ❑ Size: Diameter �---�:-Derpth----------------------------- 9 Capacity ---- Distance from nearest buiidin Privy: Distance from nearest well----------------------------- ❑ Distance to nearest lot line------------------ : -------------- - ------------------------------------------------------ : . - -- ,r. Remodeling and/or repairing (describe):- ----- � = - - --- ^^�z ------------------------- ----------------- t ' ----- 7--------------------------------4 ------.e --------------------------------------------------------------- -------------- __________ _____________ ___"------.__._--_ _ ._ --_ .. _ __ __ __ _-_ --"--_-_______----_---_.-----___----a___---_----__--_-"-----_-_-_--__--_---____-.-----_ .______—________-_-"_.._____._._._____ 1 hereby certify that I have prepared this application and that the work.will be done in accordance with San Joaquin County ordinances, State la�rulnddlations of the SanJoaquin Local.-Health.District. .__"-.(Owner and/or Contractor) [Signed) --- f f �- k r ------------ --------------------- -----------------------(Title)----------'--------- ------------ ----- . . ....-------- By:------ -- - (Plot plan, showing size of lot, location of system in relation to wei[s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- /� _�---- DATE u�• �` ---------j_-------------- ----- --------- DATE------=-------------- -------------------------------- iREVIEWED BY------------------------------------ --------- ---------- -- ------- ------ - - t DATE..---- =�--------- ---------------s----------- - - �.: BUILDING PERMIT ISSUED----------------- -------------------------------- if ------------------ -�_ ----------- and/or recommendations:. ---� � ------------- Alterations )" _ __ r— y .- T` !"_.. -------' -z-r-'.9--y'�_Z-C—a�/' - - ------------------ --.._.._ Dafie._- i -_ `z�.. C'---------------------------•---- FINAL INSPECTION BY------ --- ----- ------------- --------------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT r 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street . Stockton,California Lodi,California Manteca,California Tracyr California- A F.P.CO.