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FOR OFFICE USE: --- ------------ ------------------------------- • APPLICATION FOR` SANITATION PERMIT Permit No. ..Lolo.. .ja i --- --------------------- ----------- -------- (Complete in,Duplicate) rl 3 - - Date Issued ---1) -.-_---_----------------------------- --- T_hi's Permit Expires 1 Year From Date Issued Applicata n is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described.. This application is made in compliance with County Ordinance No. 549. V- ` 5� '_ / � k JOB ADDRESS AND ------A��4---�-- �y - wner's Name------- ,t � ef' CAKC41—---------------------------------------------------------------- --- Phone.---••------------------------------ Address---------A6-4 , ., /y1L��-- �.Cl. 1 / �/�t -�f t..... . ................� _s { Contractor's Name--- vgtvr.�-------•----•----� mx-to ----) . Phone-------- -------------------------. .. Installation will serve: Residence [�"Apartment House ❑ Commercial ❑ Trai€er Court ❑ Motel ❑ Other ❑ { Number of living units: I---- Number of bedrooms -_ Number of baths c;Z - Lot size ___ ___. . _ ----___._._-_.._ Water Supply: Public system ❑ Community system ❑ Private P?0'bepth to Water Tabla� , ft. Character of soil to a depth of 3 feet: Sand �avei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0' T Previous Application Made: (if ye's,dati '"'._,_;- ) No� ew Constructlon: .Yes o a FHA/VA`Yes ❑�'No.'❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer wer is available within 200 feet.) Septic Ta Distance from nearest well.?-' __....Distance from unclafion_XQ--------- Mater�I___�C'.IY JPE� ------------- I No. of compartments--� --.-__Size CP_.__��LLiqquid depth__� f----------Capacity Mr 'srrlp •Disposald: Distance from nearest well__`y�"...-Dista cfoun, dation_ ?v,3- -.---.Distance to nearest lot Iine_1J�0________ l Number of lines-----------------------------------Length of each line-----------------------------.Width of trencha2_1/.0------------------------ Type of filter mate aXw7 Aff-Depth of filter material---43?........... length-��A---------------------------- ! .Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_--...--.__--.- [] } Number of pits--------------- ---.Lining material-----------------------Size: Diameter----------------------_Depth--.------------------------------ r Cesspool: Distance from nearest well__-.----_..____Distance from foundation--------------------Lining mate'rial---------------------------------- .__. ❑ Size: Diameter-------------------------------- ----Depth-------------------------------------------„-------Liquid Capacity----------------------------gals. PPriv Distance from nearest well______________ ________ __=1__Distance•fromrra '"":"`"� rivy: --- , Distance to nearest lot line----------------------------- '`”` ` .:.. :' '�` . ' `-T.:- •.y Remodeling and/or repairing (describe}:--/ -_ -h'- ------------'--------- _.. "a-� -------------------- ---- --`'` ---------------- � . , ----------------------------------------------------------------------------------------- ----:--------------------------------------------------•--- -------------------------------•----------------- - I hereby certify t t I have prepared this application and T""hat the work will be done in accordance with San�"rioaquin County ordinances, State I s; nd rule rid r ulations of the San Joaquin Local Health District. nt .[Signed - =- , (Q :.artd/or Co ct _ _ BY----------------------------------------•---•------------ --------- --------------------------- - - . ( ttle)....... . y 1 (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc�jcan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----'-. t r- 0.---------------------- ----------------------------------------------- DATE------- 1r �� _ ---------------- REVIEWEDBY---------------------------------------------'•--- --------- ------------------ -------------- --------------------------•`DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------•-----------=------ ------------------------ --------- DATE-------------------------- ------------------------------ -- Alterationsand/or recommendations----------------------------------- -------------------------------------------------------------------•---------------•-----------•------------•---•---------- -------------------------_..----------..------------------------------.-------------------- ---_---_...___--.------..-_-___-_____--_-r-.--_--------.-_______{ —-.--.------.._------_.__--__-_----_-.-___-.--_------------ .- --:;�________________________________----------- ----------------------------- ..... ff ----------------------------------------------------------------------------------- _ _-.-._ _ --------------------------------------------------------- 1 FINAL INSPEC ..._ f Date--- --------------f`+ ----'- - �F----------------,- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street !! Stockton,California Lodi,California Montero,California Tracy,California F.P.CC. e.".r