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,OR OFFICE USE: -S� '30 No. /_ -3............7 . / s ,�iy� APPLICATION FOR SANITATION PERMIT Permit -------------- ws._.__`-__------_ (Complete in Duplicate) Date Issued _-----_-_-_-.___------------------- 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. S49. JOB ADDRESS AND L CATION----------7`2---------`��' l�Yr� � --------------------1/ --------------- ----- --- ----- Owner's Name_________ ____ :----- ----•---------------------- - ------------------ ---------------------- Phone--'f --- Address-----_---------------------C:. � ----------------•--------------------••--------------------- CS------------------------------------------�/f Contractor's Name-------------��f 11_ ---- ... ---- 6 t--------------- Phone..�`E;' ?----- /----- installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ (Motel ❑ Other E]Number of living units: _-�____ Number of bedrooms __�Number of baths ---I--- Lot size --._7._ --------------------------- Water Supply: Public system Community system "❑ =Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date------..------------) No �( New Construction: Yes ❑ No A FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_--_________-_--__:Material------------------------...---------------------- ❑ No. of compartments--------------------------Size-------------------------------Liquid depth--!--------- ------------Capacity----------------------- t5N -:Distance from foundation___.__!.0-�'.------Distance to nearest lo} line_____ _________ Dis osal Field: Distance from nearest well__. Number of fines_;___'____�----------------------Length of each line--_----- r �Nidth of trench-__ _-_._�_!___.._________--. a }. d------ _ f Type of filter material__._.�E�pC�_Depth of filter matenaL._..� _:_...___Total length___-_______�______ - ,�/ f � t i } 5eepaeT Distance to pearest'well___��.__fDistan rocn'4"o da i n___.��t_�----.--.Pistan5e to nearest tot line----S________ (I umber of c r _ Linin materia ____ ��_LSiz er _ 91 Deptn_.-__-__�(__________________ .l S' b - $° -' g r Cesspool: Distance from neo est well_______._.___Distance r anon....__- Lining �1Saierial_________________________ __________ T (Depth---------------------------_ Liquid Capacity gals. i Privy: D+stance from nearest t ❑ Size: Diameter------ __ ' t well------ ----'----- -------------- -- --------Distance from nearest building------------------------------------------ El ----------- ------------------- - -- ❑ Distance to nearest lot line----- --=------------- --------------------- --------------------- --- t------------------------------------------------------------- Remodeling and/or repairing (describe):----- �f------ -- - ---- a `7` �''---r �$ A ___________ ------------------------___________________-..______._____._-_____________.__ _______________________i___________._____-------_________-__________-__________ ___ 111 t _ ` _____.•______________________________________ _______________ ______.---_______-__-_______i._--___________ _________._.____________--_____ _____________________________________ ------------------------- _ �. ,—yam,. t r i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) "-- ----�inrelaf�iionwells; ------ ----- ------------------- --------------- Oand/or k _- -(� caner Contractor) BY:---------------1 -��' ------ { ------------------------------------ ---(Title)--------------------------- - ---- -------- -------- ------- (Plot plan, showing size of lot, location of sy mi buildings, etc., can be placed on reverse side). f i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- - --------t----- - ----------------------•`----------------------- DATE------0 �� 5------------------------ r _t -------------------- DATE---------------------------------------------------------- REVIEWED BY------ ---------------------- BUILDINGPERMIT ISSUED------------ = = ------------ ---------------------------------------------------- DATE--------------------------" ------------------------------ _. Alterations nd/ r recom endation : f--- --- ----------------------------------------- f • C�s3' L -- 5 � --------------------------- ------ = -------------------------------------------- ----------------------------------------------- --------------- ' ----------- - -------------------------------------- t FINAL INSPECTION BY:_-% -� -- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California