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FOR OFFICE SE: � 3 3� 3 f r �.��. _ - -- ------ ------- --------- ----------- ------------------ -----------/ .'Z---- --,_. . APPLICATION FOR SANITATION PERMIT Permit No. .,��` ....... -------------------------------------------------------- (Complete in Duplicate) z Y/ --------------------------------------------------------- I 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. 544. E . JOB ADDRESS AND ...�i...I, --�fJ_"�� _ _._r.... ,� s777777 Owner's Name--------- �� ------ Phone.•---------------- -------------------•---.-�--------------------------•------- ---- Owner's Name .. .--•- 1��1� p _+ r---......S4.aL �----------------------------•---------------------------------------- ..................... Contractor's Name................- �?.l(�__: 6P 45� ------------------------------------ -------.----- Phone---............, Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z_ Number of bedrooms__ Number of baths ._/__ Lot size .. � ............................. Water Supply: Public system ❑ Community system ❑ Private g-15epth to Water Table ,St Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam eq-1Clay ❑ Adobe❑ Hardpan Previous Application Made: (if yes,date--------------------) No.Q' New Construction: Yes ❑ No 2-1 FHA/VA. Yes ❑ No PAN TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S,-p5 Tank: • Distance from nearest well_________________Distance from foundation....................Material............................................... �l No. of compartments----------------------- -Size--------------------------•-----Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well__ a-___Distance from foundation---1 -___-Distance to nearest log � Number of lines-_______ _-----------------�__ Len th of each line_ _� 9 r l Width of trench ' Type of filter material../,�V Depth of filter material----/-jo._-.-------Total length___ __________ Seepag Pit: Distance to nearest well-----lllpeel_ __Distance fr m foundation___ �_..Distance to nearest lot --- ��'--------Depth.--.��'._._.-------__-------- Cesspool: of pi+s------f..._-_._ Lining material__ _ 17 .__.Size: Diameter__ Cesspool: Distance from nearest well----------------_Distance from foundation-----______. --...Lining material.____-_______________________________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... ❑ Distance to nearest lot line-------------------------------------- y--yam---•--------------•----- --•------------------•-----•-------••--•-----•---•--------•-------------- Remodelin and/or repairing describe --------------__ -- a�Gl��<_�'/e� ----...-- � ` __... ---------------------. ----------------•-------------------••--•---•---- ---------------------- %---------------------•---- -----------------------•----------------------------------------------•-------------------------------------.-----•-•---------------I——-------------------------- ------•----------------------------•--•--------•------- \ V -----•-------------------------- ••----------- ---------------------------------------------------------•-•------•-•------•---------------•--•---------------•----------------•----------------------------------- 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)---------------------- leXa _ ._�-` -------- ( mor Contractor) (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). FODEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- '-- -- -----------•-------•--------•----------- DATE------ ` = ------------------- REVIEWED BY.... 4 - ---•----•-----------------------------------•---•-------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------ ----------------------- --------------------------- ........ DATE--------- ------- ----------------------------------------- Alterations and/or recommendations:.-----_._ _. ------ � P rz::—, ' - '— ---------------- ' 'Z� z _ -a - .z z- - 3 ! < ----------------------------------------------------------- ----------------•----------------------------------- ----------------------------------------- ------------------------------- - ------------------------------------------------------------•-------•--•---------------------------------------------------------------•- HNAL INSPECTION BY: 1_ Date------------------------------- •-• ------- 111 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroh 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eti 0 AEVISEo B-B9 2M 9-61 ATLAS