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FOR OFFICE USE: Z!/- - -------------------�---- APPLICATI6N' *-R SANITATION PERMIT Permit No. -------- r --------------------------------------- -------------- (Complete in Duplicate) Date Issued ."O__6-? This Permit Expires 1 Year From 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. JOB ADDRESS AND LOCATION----- -5----7... --- --- ------•-- ----------------------------- ..0 -------- --------------- ' Owner's Name Phone � �c� ..0--------------- '/ -> / -- ------ �----------------- -- ....... -- - --------------------- - --------- p _ Address-------------------------------- --�----------- ---------------- Contractor's Name h�" � - ,��-- - ------- Installation will serve: Residence pg-"Apartment House El Commercial E] Trailer Court ❑ Motel E] Other E] Number of living units: _1__- Number of bedrooms ✓�.. Number of baths L_- Lot size ______4 -1 5- - - - Water'Supply: Public system ❑ Community system ❑ Private E1-"bepth to Water Table _..:-.-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [5'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________1 No ©'New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No E3— TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material-----------------___------___--- ❑ No. of compartments_________________ -------;.Size--------------------------------Liquid deft------------ - - ---------Capacity Disposal Field: Distance from nearest well... Distance from foundation___."_.---Distance to nearest lot line___-------------- Number ____. � � Number of lines------------ ----- ------ ---Length of each line--_-_-- __-�� Width of trench-___.�_ '`f--------------- ---------------- 4- Type of filter material___{-� � Depth of filter material-__/��0.._--""--Total length___.__" ------------------------ / .... _ Distance fro foundation__® ----.Distan�� to nearest lot line_-__ ' Distance.,to nearest well.-4 __ • Seepage ' f ____ - / � Number of pit Cesspool: Lining Diameter__' Depth..._ --------------- --------- Linin matenEl, al_ - Cesspool: Distance from nearest well----------- ---Distance from foundation-------.------------Lining material------------------------------------- Size: Diameter------------------------- ----- -- p ❑ De th------- -- --------------------------- -------------Liquid Capacity- - -----------------------gals. r. Privy: Distance from .nearest well-------_-----------------------------------------Distance from nearest buiWng.---_...----__._-___------------------------------ -- - ❑ ----- -------------------------- Distance to nearest lot lire.--------- -----------•--'-------""-"--'------- " - ------------------ - Remodeling and/or repairing (describe]:_-------a 3 --- --'-- - - - -------------------- •- ------------------------ ----------- ---- - -" I ----------- - - i -- - ----�-�-G' = ------ --------------------------------------- - --------------------------------------------------------- -- --------------- ---- ---------------------------=----------------=------------------------------------------------------------------------------------------------- I hereby certify that I have repared this application that the work will be done in accordance with San Joaquin County ordinances, State laws, and es nd regulatio of t�anoaqun Local Health 4District. :6 n and/or Contractor) s (Signed------------------------ �_ __ f ------------- -------------------------------------(Title)------ (Plot plan, showing size , location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l � APPLICATION ACCEPTED BY--- --`-"` DATE `'�� 5- -------------------- REVIEWED BY----------------------------------------- --------------------------------------------------------------------- ---- ------------------------------------ DATE------- ------------------------------------------------------ - BUILDING PERMIT ISSUED------- --------------------------------------------------- -------- ---------------- ------------------------------- --- �DATE ----------------------------------------- ----------------- - ---------------- ---- ---------"--------------------"------------------- IAlterations and/or recommendations: ---__--- / -- .._ --------------------------------------------------- - --------------------------------------- -•--------------------------------------- ----- ----------------- ------------------------------------------------------ -------------------- - i Date---- --`� - FINAL INSPECTION BY:___�� " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Z F.F.0 O. " '