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FOR OFFICE USE: - ------------------------------------------------------ - APPLICATION FOR SANITATION PERMIT Permit ----------- ------------------ ------ _----- -------- (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. 549. (� JOB ADDRES D LOCATION-S 't''�t'"---- �'�-C�4: --- - --------------- -------Ta -•---------------------------------- Owner's Na ----- ------------------------- ---- --- - ,- : -- Phone -- ----- ...... f r --- -- Contractor's Name C' a its. � r. r''- L'z�u``'�a"fd-------- --------- Phone. r Installation will serve: Residence rKApartment House E] Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: ---1--- Number of bedrooms--- Number baths _�Lot size ---_ ----••-------------- Water Supply: Public system ❑ Community system El Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) r -- Septic/ Tank: Distance from nearest welL._1~-d_--. ---Distance from foundation J--a-._----.Material-..- U------------- 10, No. of compartments-----.-_'2,---------------Size--- -�G � F�x Liquid depth-----4.......----------Capacity-- .. r � Disposal ield: Distance from nearest well.....�P------Distance from foundation-_-.1-Q----_--_.--Distance to nearest lot�line-X---_------. Number of lines-----------/--. -.------- Length of each line--- of trench-._�_-.---,------_------------.. Type of filter material-------- -- --------Depth of filter material____-l 4_`--_----__Total length----V @-__---__----------_ _ See pa e Pit: Distance to nearest well__-J-0h _ - - ----_Distance from foundation _11?_�+..--.Distance to nearest lot line-. ±�__-.. [7� Number of pits-------1----- -_---Lining materia -___ _ sr ze: ame - -�� Cesspool: Distance from nearest weld------ -------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-------------- ----- ---------•----------------------------------- ---------------------------------------- r Remodeling and/or repairing (describe ---• --- ------------- f - -------------------------------------------------- ✓� �, - G - - - ---- ---- ---- -------- - - - -- ----- - --- --------------- ---------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la ,and rules and regulation. of the San Joaquin Local Health District. ' _- d or Contractor) (Signed) G ` V. BY:------- -----(Title)------------------------ - ---- - ---- ----- -- - - •-------------------------------------------�---------- -- --------------------- (Plot plan, showing size of lot, location of system in relation + wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------ r -.rs7^ ------- ----------------------------------------- DATE-----------7-/ ---------- ----------------- REVIEWEDBY-------------------------------------------------- ------------- ---------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ -------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------- ------ -------------------------------------------------------------- ----------------------------------------- ------------------------------------------------------------------- ------------------------- -------------------------------------------------------------- 1 Date---��j__� ----------------- - ---------------------------- ------------ -------------------------- 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 r.P.CO.