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FOR OFFICE USE- /-/_----_. -------- - APPLICATION FOR SANITATION PERMIT Permit No. ------- f (Complete in Duplicate) ----------------- ----------..---_-----------.----------- This Permit Expires 1 Year From Date Issued 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. F 3 f JOB ADDRESS A LOCATEON____�_ _p ___----�T"-��1..�------- -- -- --- - `� 2� Owner's Name r � �::� ------------------ Phon Address- - - 1 Contractor's Named 4__`�4._..._.. __ ____ _____�__ _ __x__.__ � � -- v Residence A artment House Commercia Trailer Co ❑ Motel ❑ Other Installation will sere s L� p ❑ ❑ � Number of living units: Nu er of bedrooms _Number of baths 1�ot size ----- ._ - --------'---.------ Water Supply: Pdblic system ommunity system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil-to'a-depth of#3 fee : Sand£ �,, Gravel ❑ Sandy,�Loam_❑Clay,Loam�❑ Clay ❑ AFobe --<= an ❑ Previous Application! Made: (If yes,date..---- __ -----------} No ❑ New Construction: Yes ❑ N A/VA: Yes ❑ No ❑ It ' ll TYPE OF INSTALLATION AND SPECIFICATIONS: o Sept tank or cesspool permitted if public sewer is available within 200�fe p P P ince from ! � ti 3Jot�of compartmentst well---------------_Sizeance fru-_d• tilquid-------- depth'�_Material -------- -CapacitY__--------_�---__---- 1 } •- - j � �t ----"� al e! Distance from nearest well Q.Y�Q._.Distalnce from foundation__ 4 , k _.___._ .Distance to nearest lot-.l��__ ______4. N T e,er filter mat 1 t� Le gbh of each line,-3. -?l..------Width of trench._�4�__._____._�____�___� umber of lines---- _ r F c _ Notal length-----------------€:. V,/p--�------ 4 ��' 4 1 O Seepage Pit: Distance to neares well_ _ ��_ _ ___D.astanc from:foundation__� yp pofxfilter�matenal______ ' __�_-.�___�:Dis ante to nearest lot ne____/nS.�_ dumber of pits.... Lini material_____ _(4_C. ..__.5 ze: Diamet ___Depth_,,_ .. - � ) �6 � - . Cesspool: Distance from nearest well-----------------D�istance fromXoundtion_ ---------------��ining material__..---___.._--___.__.___1_______._- 1� Size: Diameter-----� 1 De th---- � �' ,`�Liquici CapacitY ----------- ------- � 9als. Privy❑ Distance from nearest well-______________...i_�_______ ____ __ ____Distance from neat building Distance to nearest lot line------------------------------------- ---------- -------- --=--- ----- -------------------- ---------- El m I A _ F Remodeling and/or=r' repairing �describe��-------- ------------- - - ----- - - .v---- --- - ------_;- ---- ------ ---- ---- -----------------------------• - . ------------ --------------- ------------------------ ------------------- — ---------------- ---------------I -- ----------------------------------------------------- ---- ------------ -- ------------ ------------------ • ------------------------ ! ( - ----------------------------------- - --- - -- ----- --- 4 ¢ I hereby certifiy that I have prepaed this application and that the work will be d"one in accordance with San Joaquin ounty ' ordinances, State laws, SW rules and rregulations of the San Joaquin Local Health District. �J Si nod {�t �� Contractor] { g ) `u1Rv - F B sEP-nd -rAN 4,ZE -_ ...��Title (Plot plan, showing size of lot, locatiori of system in rotation t wells, buildings, C., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ` ---D ------ DATE------------ --------------------- REVIEWEDBY------------- ------------------------- ----- ------------ ----------------------- ------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ------ DATE---------------------------------------------- -- ----------- Alterations and/or recommendations:-------- --------------------------------------------------------------------------- ------------------------ -------- -------------•---------- ---------- - ---------------------------------------•------------------------------------- ---------------------------------------------------------------- i ------------------ ------ ---- ----------.. .�` .r�----•--•..�.,�-- -------------------- ------ ------- '---------------------------------------------._._-_------------_-._._. -------_....-----_.__ FINAL INSPECTION BY: --L�_G �4 De �� -------- - ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California