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FOR OFFI E USE: -� .__ APPLICATION FOR SANITATION PERMIT Permit No..___1.-�a.ol_•9 ----------------- (Complete in Duplicate) / /7_ "�_--: :_ .�"""`: `"' This Permit Expires 1 Year From Date Issued Date Issued ______________________� ---------------------- ---- Application is hereby made to the San Joaquin Local Health District for a- per -mi -it to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. L 4 JOBADDRESS AND LOCATION ... "1� � ... -- G�nv, '-------•-•---------------------------•-------------•-•---------------------•----------- Owner's Name ----- 5�-- I ------------------- ------ Phone ------------------------------------ Address____-__--_._ t Contractor's Name__.-- I r �,I !` c -----------------•------- Phone Installation will serve: *Residence [t]-iApartment House. ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _'��__-Number of bedrooms Number of baths __, -- Lot size ..-: -- -g -------------------- -------------- Water, Supply: Public system 2Er` C ommuriity system [I private ❑ Depth to Water Table L ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Ur --Adobe ❑ Hardpan ❑ Previous Application Made: .(if yes,date--------------- ----) No 0- New Construction: Yes [8'`—No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: "(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank: Distance from nearest.well----------------- Distance from foundation ------------------- Material ---------------------------------- .---_---___.__. No. of compartments-------------------- --Size -------------- •-------•---- ---Liquid depth -------------------------- Capacity --•------------- ------ Disposal -----Dis osal Field: Distance from nearest well -__._.Distance from foundation___ ----------- Distance to nearest lot line _S__________- ,N- fir Number of lines --- I ------I ----------------------- Length of each line--------1----------------Width of trench_:__9_' -- ----------- ------------------ material ----- ----------- Depth material ---- -------------- Seepage Pit: Distance to nearest --------- Distance from fo ndation__-1Q____....__..Distance to nearest lot line____. -------- --- Number of pifs_"y ---------------- material____ :-- -___'----Size: Diameter_------0._----_-.Depth-----.-•--•--•-- •------ Cesspo(ol• Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ---------- ..___.___--__________..._._. ❑ Size: Diameter--- ----------------------------------- Depth ------------------------------------------- --------- Liquid Capacity -----------•----------- --gals. {� Privy-; l . Distance from nearest welltw y Distance from nearest building--* _____...____:'_.._..._. .� n: ❑. Distance to nearest lot line ' Remodelingand/or repairing .(describe): y----------------------------------------------•----------------------------•------------------------------------ ----------------------..._-=------ - --------------------------------------------•--------------------------••-•----------------- •--------• ---•-- --- -----•--------------- °hereby -certify that I have -prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws," and rules and regulations. of the San Joaquin Local Health District. a (Signed)----- -------------------=--------------------- ----- (Owner and/or Contractor) ------------------------ tBy: ---- . --- - ----------------------------------------------(Title)---------------------------- - ------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----- , � � ---------------•---=------------------------------- DATE---------- REVIEWEDBY------------------- ----------------------------------------•---•---------------- DATE.--------------------------------_---------------------- BUILDING PERMIT ISSUED----. -a-----'--- ---------------------- - DATE. Alterations -and/or recommendations:___ = ------ ----•-------------....--• �;� I - -- ------------------------------------------------------- '------------------- �``'' F i------------------------------ ..._______________________•-_______.-.__________...____________---__.______--___._ FINAL INSPECTION BYi.�__--------- - -------------- Date. :1 ''. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California + Loeil. California Manteca, California Tracy, California ES -9 REVIeEO a-59 F.P.EO. SM 6.60