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�. 7-7 FOR OFFICE USE: " 7 I L � 11 - - ---- - -- --- ---- ------ j1 --------------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No...�..:....T- (Complete in Duplicate) Date Issued --- ._ l _ __�i. ------------------- _----------- _------ _------------------ 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 ADDRESS A LOCATION_-- 2 -------`, - ---------------------------------------------------------------- Owner's Name "- ------------------- ...•• . -------------- e 41 Address ------.;2.4-11 .-- ---------- • Contractor's Name ....... . -- -----------------------------•--_-------------------------------------------......... Phone..---- ------------------------- Installation will serve: Reside Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... I--- Number of bedrooms ___' Number of baths .___�._ Lot size --- �pe_.,ii.(--_______________ Water Supply: Public system ❑ Community system I? Private ❑ Depth to Water Table 1Z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay x Adobe ❑ Hardpan ❑ Previous Application Made: (If yes, date ------- ._.--------- ) No y New Construction: Yey No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) Septic Tank: Distance from nearest well _-_ ___ -___ istanS� fro foundation-__%-O__._......Mat riy�l..._....... ......►..�r� No. of compartments .._.____. ---- Size___.,Z_i�__.,Liquid depth__._.! -{/,-_-.Capacity-____ _ Dispo I Field: Distance from nearest well ---- - __ _ *stance from foundation ..... 10 ........ Distance to nearest 1 t line___��.._.. N tuber of lines Len th of each line gi> Width of trench'` ------------------------ ----------------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------------------------------------- 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) ,s4 ?!?,,�tt� - ' f' f "- --------- -=----(Owner and/or Contractor) BY: ��-�""---------------------------------- --- (Title) ------------------------------------------------------ (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------------------ -------------------- REVIEWED BY-------------------------------------------------- -------------------- --..................................... DATE ---!7 ,y--- BUILDINGPERMIT ISSUED ------------------------------- S ._.-------------...................... DATE ................ ........................................ Alterations and/or recommendations: -----------------------------------------------------•---•-------•------------ ........................................... ' --------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------._.....,----------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------•- --------- FINAL INSPECTION BY:-6�-4Date- '�-1 /- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California EL -9 REVILED 8.59 r.P.CC. 2M 6-60 u------------- - --- g ....... ----� ........ -------------------------- Type of filter material__ . _-Depth of filter material ---- /-,?___-________Total length -------Q___________________________ \ n Seepage Pit: Distance to nearest well ______________________Distance from foundation -------------------- Distance to nearest lot line __--____-___-__-_ Vl ❑ Number of pits_____________________ Lining material ----------------------- Size: Diameter____-____________.-_--_ Depth ____--.---_--___-_--_-_-_____-,__ Cesspool: Distance from nearest well ------ _---------- Distance from foundation. -_-__.____-._.-:-_.Lining material ..... ................................. ❑ Size: Diameter----------------------------- -------- Depth ---------------------------------------------------- Liquid Capacity ............................ gals. Distance from building Privy: Distance from nearest well --------------- _--------------------------------- nearest -__•--_.-___--_-___-______-__._--_-__-_-_. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------._----------------------------- �Q Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------- -------------------------------------------------•-•-----------------------------------------------------------------------------------------------------------------•------------------------------------------------------- •---------------------------............................ ------------------------ ----------------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------------------------------------- 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) ,s4 ?!?,,�tt� - ' f' f "- --------- -=----(Owner and/or Contractor) BY: ��-�""---------------------------------- --- (Title) ------------------------------------------------------ (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------------------ -------------------- REVIEWED BY-------------------------------------------------- -------------------- --..................................... DATE ---!7 ,y--- BUILDINGPERMIT ISSUED ------------------------------- S ._.-------------...................... DATE ................ ........................................ Alterations and/or recommendations: -----------------------------------------------------•---•-------•------------ ........................................... ' --------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------._.....,----------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------•- --------- FINAL INSPECTION BY:-6�-4Date- '�-1 /- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California EL -9 REVILED 8.59 r.P.CC. 2M 6-60