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vr< vrri%.r- u3t; T T ---------------- --- ------------------------------------------- .. .. .. _. ---------------------------------------_.-._ ----------- APPLICATION FOR SANITATION PERMIT Permit No. _a2rs1, (Complefe in Duplicate) --- --------------------------- -------- ------ --- This Permit Expires 1 Year From Date Issued Date Issued 7:- Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal( the work herein described. This application is made in compliantwith-County Ordinance No. 549. JOB ADDRESS AND LOCAT N _, Wit.-_:7ta�a,�. a ` Owner's Name.__`__- }. 4- ------ .----- ,, - -•- -- • ----- --------- --------------------- Phone--------- Address---------- �-•- -- a j --- -- ----1-1----'-- e_.. ----- - ---•---•----Contractor's Name------ Installation will serve: Residence Apartment House f] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:,'_/__-- Number of bedrooms _i'- Number of aths -_/__ Lot size ___11 - -�rR ---------------•-------- Water Supply; Public system ❑ Community system ❑ Private Depth to Water Table -- ----- ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel Sand LCla❑ Sandy ❑ Y Loam ❑ Clay ❑ Adobe ❑ Hardpan 0--- Previous Application Made: (If yes,dote____.-_-- __.- 1 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 feet.) Septic Tank: Distance from nearest well________________Distance from foundation____.__.___.____.Material______.....______________.------_-_ El No. of compartments '--Size-------- ------------------Liquid depth--------------------------Capacity- -- --- Dispos Field: Distance from nearest well. ~a D ancefrom foundatio`n:_____1,0-�_-.-.-pistance to nearest Iofi fine._•r� ---• Number of lines_.____. _.' --------- Length of each line sp_' "--------- Width of french- - " �. Type of filter material_`-, J`7.r2 -----s._-----r-----Depth of filter material-------I- r Total length------_��-'-__-•----------------- Seeps Pit: Distance .f nearest wall_._/ew------_`Distance from foundation__--��1-'_�_.__..Distance to nearest lot line_. Number of pits---- _'� ------------Lining material_: f��_._----Size: Diameter-------3- "_--.De th_ - _ ' I P ------------ ........ Cesspool: Distance from nearest well_____--____ Distance from foundation'.-.._.__._.__-___..Lining material__________________________________ ❑ Size: Diame#"er- -- ---------------- T Priv l ; .. 1 ------------Depth-------- ---------- ------------------Liquid Capacity- gals. re Y Distance from nearest well-------------------------------------------- - -Distance from nearest huildin 9 ------. ❑ Distance to,nearest lot line__ _________________________...._ Remodeling and/or repairing; (descrilae)----- - ----------------�------------ -----•__---------------- -------------------- ---- ----- rt'.I ----------------------------------------------- -------------------------------------------------- M -------------------- - ------------------------ hereb t,f that I have re ar --------------------------------------------------------------------------------------------•-------------- ------------------------------------- ------------- Y � Y p p'r'ed this application and that the work will be done in accordance with San Joaquin County ordinances, St +e aws, and rules and regulations of the San Joaquin Local Health District. (Signed _ _ l - ---`-------- �_ ------ and/or Contractor) ---------------------------------------------------------(rile)-- ------------- ---------- ---------------- ...----- --------.--, (Plot plan, show, size of lot, loca+ion of system relation to wells, buildings, etc., can be placed on reverseside). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__-.___ _________________ DATE._ .� ___ ___________________--__ WED BY---------------- r ------------------------------------ ©ATE BUILDING PERMIT ISSUED---••----•-------------------- -- -------------------- DATE------ Altera+ions and/or recommendations___ ______ `----------------------- ------------- --------------------- - -------•--- ------1-• ---- --------- - -------------- ---- --------------- --- ----------- - - - ----------------------------------------- _ y FINAL INSPECTION BY:..'.._ .�' ----------- pate SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.