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t1O R OFFICE USE: ----------------- - ------------------------------------- ---------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. 1. ------------------ --------- ------------------------------------------ (Complete in Duplicate) Exeires 1 Year from Date IIssued------------------ - -------------------- ----------- This Perlm'it' 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. S49. 44-��5�E.Aj t"-- .. 4 JOB ADDRESS A LOCATIC ---- Owner's Name- ------_------- on------ ---- ---------------------- Address.. Contrac or's Name--- ------ ---- - ---- ---- --------- Phone--_.. ------------------ ............................... Installation will serve: Residence artment House E] Commercial El Trailer Court E] Motel F] Other ❑ 'Number of living units: Number of bedrooms .-/---- Number of baths Lot size --------------------------------- Water Supply. Public system F1 Community system El Private*1 Depth to Water Table "-V ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam Clay 0 Adobe[:] Hardpan El Previous Application Made: (If yes,date-----------:--------) N 0 New Construction: Yes ' No E] FHA/VA: Yes El N o� TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)._ Septic-Tank: Distance from nearest well-_______.___----Distance from foundation--------------------Material .No. of compartments----- ---------------------Size-------------------------------Liquid depth-_-------------------- ---Capacity ty---------- ------------ Dispo$0�Fi.0d: Distance from nearest well______________--,Distance from foundation--------------------Distance to nearest lot line._.__________-___ Number of lines-------------------- X------�--Length of each line------------------------------ Width of trench----------------- Type of filter material--- _!Depth of filter material-----------------------Total length-------------------- ------------------ Seepage Pit: Distance to nearest well_-____ ----- ----- Distante from Wriclafion---lel-"........Distance to nearest lot line ;-6i� Number of p;fs----/--------------Lining' --- e-j material -w-- Or------Size: Diameter--- I------------Depth------- -4�1--------- Cesspool: Distance from nearest weJ1-------------------Distance from foundation--------------------Lining material____._..______-_____._ --r--.. „❑= T,.� =..,S aterial----------------------S ize: D ia mete-r--------------------------------------- Dep�b--------------:-------------------------------------'---Liquicl r-Ca ► Distance from nearest well-__._______ f-------------------------------Distance from nearest building---------------------------- ❑ ti, Distance to nearest.rest I ------------ ot line--- ---------------------------------------------------------- ---------------------------- ----------------------- Remodepng a /or-, pairing (clescribe):-- ........... I-�19- - - -------------------------------------I - -------- -------------- ----- ---------------------------------------------------------------------------- ---------------- _ ---------•----------•----------•--••-•---------C------- f ------------ --- ..... --------- -----------------------1-1--------- i ,7----------- ----------------- ---------------------------------------------------------------------------------------------------- -----•---------------- ,,-w ---------------- ---- ---------------------------- ------------------K.�-----i---------------------M----`---------- -------------I---------------------------------------------------------------------------- -114 it I I' — ........... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesi-Sfafe laws, and-rule rid.r 9 lation f the' n Joaquin Local Health District. (Signed - - ---------1!2.. - -----t-------------------------------------- (Own ancl/o�r Contractor) 0�1/...... By:------------- itle i - - ------------------------------------I------------------------(Ti --------- ................ (Plot.plan, sho f I ,.'location Of system in relation to wells,-buildings,.etc., can be�P[��acedbn�,re so sidej) Fd k DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ----------------------------------------------------- DATE----------- ---------- ,REVIEWED BY-----------------/ 1 ��- ---------- --------LJJD-------------------- ---------------------- DATE---------------m BUILDINGPERMIT ISSUED----------------------------------------( ------------------------------------ DATE------------------------------------------------------------- Alterations and rec.4mmendations ------------------------I-—------------------------------ ............ .......------------)L------------------------------------------------i j k I ---------------------------------------------------------------------------------------------------------------- ---------- ---------- --- ------------------------------------------------------ 41 %�--- - Q- -- ----- -------------------------------- ----------------•-----------•------• ---------------------------------------- --------- N.... ----------)-------------------------------------- ----------- -------------------- -------4,- -4, -1 ------------------ -----------------:------------------------------- --------------------------- ---------------- ------------ ---------------w-------- ------------ - ------- ------ ----------------- -------------------------------------------------------------------------------- - ----- ---------- ------------- '00' FINAL INSPECTION BY:------.... Date--------------------- --- ---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California E5-9 REVPUED a-sq r.p.=2M 6-60