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ICE USE: __ APPLICATION FOR SANITATION PERMIT Permit No. ...._.-..- -... ------------------ ---------------------- ------------------------------------- -- --- -- ------ (Complete in Duplicate) Date Issued -------------------- ---------------------------------.:.- This Permit Expires 1 Year From Date Issued 3gl (e Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and insk here de�scrbed This application is made in compliance wit County Ordinance No. 49. �JOB ADDRE ND LOC TION t3 .- � -� Y �' ---------•-----Owner's Na /�W_� ---------- ,�� ../ .: ----------- -- -- Address......... .... _ -----•-••----•-----------------------------------•------- Contractor's Name.._-- Phone-----.•------------------ •--••--• G Installation will serve: Residence gK_A__partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:;__ -_.Number of bedrooms J- Number of baths /--.- Lot size.;orX__1371------------------------------- .C3 Water Supply: Public system. E] Community system E3 Private Depth to Water Tabl"J'0 ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Cla Loam ❑ Clay ❑ Adobe Hardpan P ❑ ❑ Y � Y Y ❑ ❑( Previous Applica+ion Made: (If yes„date__---------_--------) No New Construction: Yes ®moo ❑ FHA/VA: Yes &/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well �-.-_ Distance from/f�oundation--�Q-:------.Material-- , .E----- ---------------- \ No. of compartments----A--------------- Size��--X_-ti6'�---__.-Liquid depth--- !----------Capacity-- -- -- ------ i Disposal Field: Distance'from nearest well-4-P---.-Distance from foundation_-AP---i----..Distance to nearest lot i Number of lines------ ---------------- -----�- ength of each line-� `--.. �__..Width of trench-'t----------------------------- qj Type oflfilter material/ ,--- —Depth of_filter.materiaL./_�'�-------Total length____11e9,ie7------------------------- Seepag Pit: Distance to nearest w0__f-f - -1---Distance'from fou dation-----W__---.Distance to nearest lot ii� Number ofypits.___�-------------Lining material__f��E .Size: Diameter. �_..----Depfn.�---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.-------_--._----.-._-------_-.--- ❑ Size: Diameter- :-`*--=----- -------------------De t.h-------- -------`-------- -- ------ ----Liquid Capacity gals. Privy: Distance from-nearest well'--.-.'.'-__--_--__.'----..__-------------:_.,Distance from nearest building------------.------.----_--------_-------- ❑ Distance to nearest lot line------------------------------------------------------------------ ----------- ------------------------------------------- ---------------------- I R Jelin or repairing'(describe :---. ------- ------- -----_----_--------- ---_ ------• -------- --- ------------- - -------------- -- ---- --- -- - `-- -------a-�'``_� ?"�' ------------------------------------------- -------------- ! hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru es and regulations of +he San Joaquin Local Health District. a (Signed) --------------------------------------� eown reetd•/or Contractor) ------------------ - i -- ----------------VwAells, buildings, (Title)-- 1 (Plot pl�n, showing size of lot, location of syste relation to etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY {,1 --------------------------------------- DATE-------- f REVIEWED BY ---------------- - - •--- ------------ ------------------r--------------------------------- DATE -------------------- r BUILD+lVG PERMIT ISSUED -= - ------ DA-TE------------------------------------------------------------” .. .* .,::... .a.. _ Altera ons and/or recommenda+ions------- --- ----- --------=--------r------ ------•----..-..----•-• ------_- -•-••---....------------------------------------------ ---------- ----------- -------•-----------------------•------------- --------------••--------------------------------------------- -------- --------------------------- ----------------------------------------------------------------------------------------------------•------- ------------- ------ -------------f-•------------•-------- -- -----••-------------•-- ----•------------ r FINAL INSPECTION 13Y: Date_- Is- ; SAN JOAQUIN LOCAL HEALTH DISTRICT I a 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street 1, Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.F-.CC. I y