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FOR OFFICE USE: ti _. ----------------- - ---------------------- --_.____ -__...--. ._. APPLICATION FOR SANITATION PERMIT Permit No. .. - 7__--..__.... i ----------------- -------------------------------------- {Complete in Duplicate) // This Permit Expires 1 Year From Date Issued Date Issued ._ _ .(�C�_ Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549,i o 4s�G � JOB ADDRESS AND LOCATION------4-o-7- _` [ Owner's Name0-------- ------------------------------ --------------------------------------- Phone------------------------------------ Address----------- ---•----------------- -Address-----------r ate' ZIT r_.a _ %. • ------------------------------------- Contractor's Name - � -------------------- -----------------------------------------•--- Phone..'VA_YPJ^J-_7__>_i_:__ Installation will serve: .Residence E- Apartment House 01 Commercial [ITrailer Court [IMotel ❑ Other ❑ Number of living units: _�_-___ Number of bedrooms _3i_-- Number of baths _L____ Lot size .. Water Supply: Public system ❑ Community system ❑ Private [ice Depth to Water Table 2.'C- ft. Character of soil to a depth of 3 feet: Sand ZT`r7ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes Rc -- No ❑ FHA/VA: Yes ❑ No �J— -TYPE=OFANSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer lss available within 200 feet.) Septic Tank: Distance from nearest well-_gip-f___--Distance from foundation___1_ `-------Material---- Kl' No. of compartments-.---_Z --Size =X S� r 00" ---,---Liquid depth------ ---------- Capacity_°_ Disposal Field: Distance from nearest weli----'Q-f-_._Distance from foundation.._;_4__f_______-Distance to nearest lot line___' ®� Number of lines---.-----=%-------------------Length of each line----- 9 f".`Width of trench-------4�_ ._.................... Type of filter material------8o- -----Depth-of-filter material_'_._ _�.....__._.Total length_______0_9 r____________________ - Seepage Pit: Distance to nearest well--------------_---_---Distance from foundation--------------------Distance to nearest lot line___---__.__.._-p Number of pits----------------------Lining material---------------.-------Size. Diameter----_------------------Depth---------------------------- - -- Cesspoo: Distance from nearest well-----.----------Disfance from foundation___________________ Lining material__._._._______..___._ ._ ❑ i ameter Depth'---- ------------------------ ---------------------Liquid Capacity--_------------------------gals, Privy: Distance from ne t well-------------------------------------------------Distance from nearest building--------------------------------- Distance to nearest lot in --- ----------------------- ------ --------------------------------------------------------- Remodeling ------------------------ -Remodeling and/or repairing (describe}----------------------------------------------- {'-- • -------- i ---------------------------------------------------------------------------------------------------------------------------------- -------------------------- 1, - y - - ---------------------- - F � ----------------------------------------- --------- ---------------------------______________ ___________'__________-______________-_______________.__-________.____-_._ ______.__________._-__..._-.___________...__._....____ 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 5an Joaquin Local Health District. (Signed)----------- - �- ------- _-------------r ------------------(Owner and/or Contractor) - Y ----- ^ = _ T ----- ---(Tit e)=Y "= <" ... ...--:... (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY--- ------ - ----------------- / DATE REVIEWEDBY ---------:--------------------------------------------- --------7"-------- DATE--------------- BUILDING PERMIT ISSUED--------=--------------------------------------------------------------------------------------------- DATE-------------------- Alterations and/or recommendations---=------- ------- ------------------------ ------ = - l --------------------------••---•------------------------------------------------------------------- ----------- -----------------------------------------• --------------------------' { t - --------------- ----------------------- r ---------------------------------- --- - - --------------------- --•- . . FINAL INSPECTIONIBY:---- f ----------------------- --------- --- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,Cali' a forniLodi,California Manteca,California Tracy,California