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-,FOR OFFICE USE: ------ --------- -------- Permit No. p` � ------------ ------- APPLICATION FOR SANITATION PERMIT ----- ------ ' (Complete-in Duplicate) Date Issued _. _ This Permit Expires 1 Year From Date Issue Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the rk here dibed. This application is made in compliance'with County Ordinance No. 549. ,r,2 e ----------------- JOB ADDRESS AND L CATION.. _i-"�-'- ----- -------- ----------------" # '' ------ ne------------------------------------ ' Phone Owner s Name-_.._ ----•------------- ` - I Address . "�orr�irr• - c c `I --- Phone------ ------------•---••--•------- - ---- --------- - Contractor's Name----- 4 r. a urt ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer �- I t-- Numbe of bedroom Number f baths_..-""-- Lot size ----- --- ------I -------------------- - Number of living�units:�.-� � Water Supply: Public system ❑ Community system ❑ Private [Depth t Water Table ------ _ ft I { r I la Adobe Hardpan ❑ Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ C y ❑ t ❑ I, + Previous Application- Made- (If yes`;date_.1_. ,1......-- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ # r TYPE OF INSTALLATION AND,SPECIFICATIONS: (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) sI ` --- ---- -------- Septic ank: Distance from nearest well_..____._Distance from foundation__-_./t?-- --Material _-_- t r / Capacity ��`•�`�- No. of compartments_. _ Size-- -•- -._ yy q P 3-�"-` , Li uid.d'e the-- �.� Dispos Field: Distance from. nearest well ---- Distance from foundation_...�0.-___..-.Distance to nearest lot line i Number'of lines-------------- ------Length of each line__.__ca_� Vdidth of trench.__°�-_____-.�_-_"-------------- --------------- T Type of filter''material---_--~ - .-'----- Depth of filter material------- -------------Total length-----�-��----- G` Seepage Pit: Distance to#near`est well`-_-:- -�"�=Distan'e,from foundation_- "� -,_-___Distance to nearest lot line-------------- -- Seepage material Size: Diameter----------------- ----Depth-------- ------------------ - �. IF ❑ I i __ Cesspool: Distance from nearest well ..._---___-_---Distance from foundation- --------___. ..Lining material_-.__----.----- gals. ❑ ' Size: Diameter --- Depth----- --------- - ---- -------------- -----Liquid Capacity----------------------------g Distance from nearest well-------------------------- -Distance fromnearest building............................. ---------- Privy: # ¢ I ❑ - = , Distance to nearest lot lire .. - - i ------------- _ (• ri C) -I------------------------- --------------------------- Remodeling and/or repairing (describe)--- -------------- ------ ---------------- ---------------------- I i # ---------------= ----- --------------------------- tI - ------------------ ----------- _ ------------------------------------------------------------ --- - -- ------- Il --------------- ---•-----"------------------------------------------------------- ---------------------•..................... - ------I--------- ---------------------- - t 1 hereby car+ify that Ihave-prepared this application and tha+ tke work will'be"coria`in accordance San Joaquin County ordinances, State , and rules and qreullattions of the San Joaquin Local Heal#h District. r-- (Signed - --- -- -- --- ---- - _ n or ontrac or(Plot plan, showing size of lot, locatioem in r +ion +o wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__- it ''_ • Z �r. DATE__.��.` ------- ------- REVIEWED-BY----- --------------- --- ----- --- ---------- ----- DATE--_" ."=--�'--�-'T�--------�'�------------------• ---- .; ---------- ----- ------- i BUILDING PERMIT ISSUED • - - --- ---------- DATE------------------------------------- ------------ ------- Alterations and/or recommendations: -------- ------------ ------------------- -------------------------------- •--------•---- f - -- ------------------- -------------------- -------------------------------- ------ . ------------------------------------ - - - - ----•----- --------------- ------ ------ -------------------------------------------•------ ---.._..----------------------- ------ -------------- -- ---------- --- ------ -- ------------------------- ----- ----------- ---------- FINAL INSPECTION BY: 04, .-- '?' -' - Date- -- _ - ------------------------ ----- t SAN JOAQUIN LOCAL HEALTH DISTRICT 16 01 E.Haselton Ave. Soo west Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Loch. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press