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FOR OFFICE USE: ------------------------------- ---- ----------- -- ---- --- -- --------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. 0j,R-�_79. -- ----------------------------- - (Complete-in Duplicate) - - --- This Permit Expires 1 Year From Date Issued bate 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 AND LOCATION- d- .. ..- ------------------------------------------ Owner's Name__________ ___ � " _.-S,t �g�-- �( ----- - - -------------------------- ---- - ------------- - ---- - Phone------------------------------------ Address----------//P, -------------------•._----------- -Address----------//P,Q- 2...�.,(�.. ••r` --------------- Contractor'sJL. . --`-1=-- ------------------------------ ----- -------------•--------------- Phone:.'4.4�F4D 7---•------- Installation will serve: Residence rtment House ❑ Commercial ❑ Trailer Court [] Motel Other ❑ Number of living units: --- Number of bedrooms-_._ Number of baths I_._ Lot size ____-__ . .-_ /�ffC�17;a r^ Water Supply: Public system ❑ Community system ❑ Privatea?�_Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.-._.---_--- ---..- ] No ❑ New Construction: Yes ❑ NaFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Z (No septic tank or cesspool permitted if public sewer is available within 200 feet.) &1_�_, No. Distance from nearest well_...__-----__--Distance from foundation____________________Material ___.__-____....._of compartments------------- -----------Size------------------- -------=---Liquid depth--------- - ----- ------- Capacity--•-------------------- ispo I Tel Distance from nearest.well.°� y-. Distance to nearest lot line____.-1�� .S_-..._Distance from foundation_ _ _.__-_ _._. --.- ----- Number of lines.___/___-_ Length of each line-_I_Q,11?'---------------Width of trench--- S_ _�� Type of filter materia ___._.Depth of filter material---lf..-_--------Total length-----------------------/40V____-__-- Seepage Pit: Distance to nearest well------------- --------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits--- ---------------- Lining material------------------- -- Size: Diameter.---_--------.__.---.Depth--------------------------------- Cesspool: Distance from nearest well _______________Distance from foundation .... ..Lining material------------------------- ❑ Size: Diameter- -- -------- ----- ---- -•,-------Depth---------- ----- --------- ------------------------Liquid Capacity-------------- -------gals. ' Privy: - " Distance- 'from nearest well :,.------- -_-_...__--------------------------Distance from nearest building_--.__..__---------__________._---_-__. ❑ Distance to nearest lot line_.-----------�R=-- -- Remodeling Remodeling and/or repairing (describe):__-_--- At,% ---------- -__-__--•_--_-- - ----- ^ E ------------ 1i. ------ - ------ ------------------- - --------------.......... ----------------------- -------------------- --------•---------------------------------------------------------------- ----- -- ----- ----------------------------------------------------------------------- ----------=s I hereby certify that I have prepared this application and that the work will beAone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin,Local H a h District. s _ _ (Signed)_- -. .... Contractor) SY:------------------•------------------------------------------ ---- ----------------- --------(Title) - - (Plot plan, showing size of lot. location of system in relation to Ils, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- ------------------ - -------------------------------- DATE--- 4� -- ----------------- REVIEWED BY If - ---------------- - -------------------------------------------• DATE-- ------ BUILDING PERMIT ISSUED_- ---------- Alterations --------Alterations and/or recommendations----------_________..... ____-----.._..._.._...._._....___ -_ ----- --- ---------- ----------- ---•----------------------------------------------------------- ------. ----------•------- ---------------------------------••-- -------------------------- ----------1-1 -------------------------------------- -•- ------------- ----------------------------------•-- ------------------ - ----------- ------------------ - ---- - ------------ ...... --- ........... --- - --- ------------------------------------- - •----- - --------------------- ----- -....--------_.._.. ---- -------- FINAL INSPECTION :.. - -- - - ---------------- Date... A OAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California 4 E.H.9 2M 1.67 Vonguard Press