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�r r � ` n { � 1 U y APPLICATION FOR SANITATION PERMIT Permit No. _.___ _. _.� r ti1 Complete in,Du ligate P Date Issued ..------�� / C) This Permit Expires 1 Year !From Date Issued `;Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. iThis application is made in compliance with County Ordinance No. 549. } V7 JOB ADDRESS AND LOCATION------=------------------- s -------• ----------- Owners Name----------------•--•- - - -----------------.m------------ _ Phone...-••-•--------•-------•• •----•--• �— / = `l': 1 n------- ---------------------------------=------- Address-------------------------`---•------------------f- a r Contractor's Name---- = _ ----------- ------ Phone - Installation will serve: Residence [( Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._r__ Number of bedrooms _ --- Number of baths --_/_- Lot size ------- ------- - Water Supply: Public system Community system ❑ Private ❑ 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: Yes E] :No JKNew Construction,: Yes ® No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from ne'a' rest weli_�Q/l��__Distance from-foundation-__- Material_-_-____�X-f��..C:�_. ------ Size- ti^., ---------.—Li uid de th---------- --- No. of compartments----- -.0�. q p Capacity__---- 0-:--- ---- Disposal Field: Distance from nearest well...IUGAJ--__Distance from foundation.... - .._.Distance to nearest lot line___.......... Number of lines-----'-----------/-------------Length of each line-----------y -----------Width oftrench---------- :Z!-------------_._-:. Type of filter material---- '_ ......Depth of filter material....ZS'p-----_!_Total length.,---------------- /P._-_----_-----__ Seepage Pit: Distance to nearestls well_4�Ca/Il _.____Distance from foundation___. ______..D;ta to nearest lot line_..__._! _.... �h �[ Number of pits.--:'.!-- /-----------Lining material--_,; ..Size: Diameter- _X__ -.-.----Dept h--------- ;-..-------__- r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mater'ial--------------------- ______.________ i s ❑ Size: Diameter- ------=-----'��-=--;--- -------Depth-------------------------------------- --- --------Liquid Capacity- -----------------------gals. I Privy: Distance from nearest well'-----------------------------------------------Distance from nearest building------------------------------------ ❑ Distance to nearest lot line-- ----------------------------------------------------------------- ------------------^------------------------------------------- Remodeling -µ---------------------------------- ---- Remodeling and/or repairing (describe)---------- I----------------------------------------------------------F------------•----------------•----------------------------------------- ; -------------------------------------- ----------- I-------------'---------------------------•------------------------------#------------------------------------------•---•--•-------------------------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t San Joaquin Local Health District. ' / .-. --------(Owner and/or Contractor) Signed)-----�- --- - =--- _O��yc.'L/'� --.... - ----1 -------- ----- ------------------------- - , BY:---------•------------------------- --- ---- ------------- ------- -------------- -----------------------------------------(Title)------------------ -- - ----------- - (Plot plan, showing size of lot, location cf system in relation to wells,"buildings, eft,/an be placed on reverse side). FOR DEPARTMENT USE ONLY j-� APPLICATION ACCEPTED BY------- __ ._ ri2� ------ ---------- DATE-----_, C? '"� ��----------------- REVIEWEDBY--------------------------------------------------- =-----------------------------•------------------------------...---•--- DATE--------- -------------------------------------------------- BUILDING PERMIT ISSUED--------------- - -------- DATE------------------------------------------------------------- -- -- ---------------------- Alterations and/or recommendations:'--3------- j-----, -�--------------------------------------------------------- ---------------------- ---?-------- --------------- -------------------�----- ----------------------------- f - "' ! � � .i, -- y ----------------------- ------------------------------------------------------------------------ \ ! ------------------------------ ----- ---------------------- --------- f- ---------------------------------- - - ------------------------- - --- ------ ------------------------------------------- --•- Z�:FINAL INSPECTION Bim---------- Date.... �p -•---- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street I 132 Sycamore Street 814 North "C" Street Stockton;:,California Lodi, California Manteca, California Tracy, California ES-9-2M Revised S-'59 F,P.C.. �^ E f