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FL-JK UrriLt UZ)t: ---------- -------------------------------------------------______ APPLICATION FOR SANITATION PERMIT Permit No. _._ -•�,� ------------------- ------- - -------------- -------- - ---- . . (complete in Duplicate) ---------•--------------- -=-- gThis Permit Expires FYear From Date Issued 'T �-�-- Date Issued Application is hereby made to the San Joaquin Local Health District for a perrriiqt�7to.construct and install thew rk herein described. This ap liliocation is made_in compliance with County Ordinance No. 549. � JOB ADDR 55�p L.00�ON�n � �jrt, ��i��/�' �r �� Owner's Name= {` .. fit y_ l-�xg ------------------------------------------ ---- ---------------------------=`-" __. j� 4 Address Xr ----------------------------------------- Phone ----------------------------- - .1 ------- --------------------- ----------------------------------- Con#rac#or's Name fhLf__ =�. -- ❑ p ' ----------------------------------------- Phone_-,------------ Installation will serve: Residence Apartment House Commeraal TrailerCour# ❑ Motel ❑ Other Number of Irving units::.--- -- Number of bedrooms ___.____ Number of baths - Z` se Lbt ___, �: Water Supply: Public system. ❑ Communitysystem f f y ❑l �Prrivate� Depth to Water Table ___..-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravely Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El Hardpan ❑ Previous Application Made: (If yes,date-------- ------ ) No� New Construction: Yes No f ❑ FHA/VA: Yes ❑ No� ; TYPE OF INSTALLATION AND SPECIFICATIONS: ' 4(No septic.,tank cesspool permitted if public sewer is available within 200 feet.) f--. Sed is Tank: Distance from nearest welt_ ,X,Ni1•tpistance from founclafion__._ _ No. of compartments_._---�f_Z!� $z � _ r ' Liquid depth ----Capacity.. �_b� -} --------- - Dispo�I Field: Distance from nearest well.:.._--.�j_._f��r`sYance from foundation__- --------------Distance to nearest lot li e_______:'" Number of lines------ ------ - -------_Length of each line-------- -----_---Wid#h of trench--- ---, . Type of filter material---- �� epth of filer aterial_ --Total length___-- ,- ---------------- ----•---- Seepage Pit: Distance #d nearestwell-------- ... --___Distance from foundation__ _______-___.__.Distance to nearest lot line----__-__-._____ ❑ Number of pits---- --------------Lining material----------------'--...Size: Diameter--------- Depth �. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- ❑ _ w Size: Diameter-------------------------------------- - Depth --------------------Liquid Capacity- ---- ---------- gals. A.-..� :•-�. - . ------• ----- Priv y Distance from nearest wel-------- ______ _____ ______ ____ _ Distance from_nearest building_-"El _'--------------------- -----------------` ___ " Distance to nearest lot line__-_ ---- ---------- -- -- `-�--------- Remodelin and/or repairing describe :______--e—r- fl , __ `-- � ��1`I+ g / P -te-sem. �i� ------------•-------------------------- --------------------------- -----------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County x ordinances, Stat laws, and rules and re ions of the an Joaquin Local Health District. y (Signed)-N_ _ -- -- ---- --------------------------------------------------------------- -----------(Owner and/or Contractor) BY = =t- ---------(Title)------------------ ------ ------------------------- (Plot plan, showing size of.lot, location.ofrsystem in relation,to wells,'.buildings_etc.,,can be placed on,reverseside).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------- ------ -------------- ------------------------ = iSATE---- -1 REVIEWED BY--------------- - ---------------------------- -------------- ------------•------------------ DATE---�-----•- ---------J- - -------•-------------._ �f BUILDING PERMIT ISSUED- DATE Alterations and/or recommendations:_______.-_---.__.______- - ------- -------------------------------------I--------- -------------------- ---------•----------------- ------ ------ -; - ---- -- -- FINAL INSPECTION BY:--------- - ------------ --------------- ---- _ Date-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT '} 1601 E.Hazellon Ave. 308 West Oak Street124 S ycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California IES 9 REVISED 8-59 3M 3•163 i.p•CD.