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FOR OFFICE USE: ------- Permit No. . /�a -- -----------"-----_. APPLICATION FOR SANITATION PERMI (Complete in Duplicate) Date Issued -.----- " ----- ------_-- ---_ --- ---- ---------"--- Z z 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 wo herein described. This application is made.in compliants with Coinina c o. 549. � �crr. : JOB ADDRESS AND LOCATION_ --,- Owner's Name-.--,76- --------------------------------------- ----` ----------- ------ -- Phone----------•----------------------- --------------------------------- Address-----•------ /-7.0- --------- ------ -+ -------------- k -------- G — ---------------------------------------------------- Address -------------•---- -------- .... --------- . Phone------------------ ---------------- Contractor's Name _ -------- --- -.�-_ Installation will serve: Residence Apartment House ❑ Commercial El Trailer Court E] Motel ❑ Other ❑ i -_-- Number of baths __1 Lot size ---- --h- -- ---- ----------------------------- roomst Number of livin units: _f---_ Number of bedt 1 k g a Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand C3Gravel �Sancly Loam ❑ Clay Loam [I Clay [-] Adobe E] Hardpan � "+ r-O I ElPrevious Application Made: (if yes,date-----------,---_--- 1 No New Construction: Yes ❑ No E] FHA/VA: Yes E] v TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well__,_ Q--r----Distance from foundation__-j - -----"-Material____ 1 -` fes ---------------- No. of compartments----_-- .------ ---Size- fo--A� x".S'._--Liquid depth--- --- -------------- P Y I Dis os I Field: Distance from nearest weil__r��4 Distance from foundation_1®."-------Distance to nearest lot line$_-�._ p� to Number of lines-------- Length of each line-_.��---------�� ----� Width of trench_-�-----:�----------- ------- I Type of filter material____._-`^ _s .--------Depth of filter matenal_____E_rl'--.-_____Total length_.-._-. ---- , --- Seepage Pit: Distance to nearest'%'ell_P� ________________Distance from foundation .Distance to nearest lot line-------------- Seepage of pts -- .------Lining material-- Size: Diameter--------- -------------Dept --------------------------------- Cesspool: Distance from nearest,'well_________________Distance from.foundation___-____-_--------.Lining material-------_-_--__----.-____-_____--_____. f `� __Li Liquid Capacity -------gals. ❑ : Diameter_ - '- ------------------ Depth_.------------I------------ Sizeq P Y- } -_-__--Distance from nearest building ----------------------------------------- Privy: Distance fromilearest well__-----.-__- -- --------------- e -------- ------------------------- ❑ ----------•----------------------- ------------- Distance to nearest lot line_=___----------- ---------------------- ---- -- - I N t ! Remodeling and/or repairing (describe):__-_ ._-- ---------- - ---------------- ------------------------------------------•- -------------------------------------- ( -------------------------------------------------- I t ------------------------------- --------------------------------- ----------- ----- i -----------•--------------------- ----------------------- ---------- r I ---------------------------------- --------------------------------------------------••------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. 1rid/or Contractor) (Signed)-------- --- ------ -"------ ------------ -"--- ---------- ---------- ----- ---Aly'd -- -------------=-----------------(Title--------------- -- ------ - ------ - -------------- -- --- -- ---- }BY� F ...(Plot plan, showing siie oflot,location 0Sstm in r anion to wells,'buildings, etC.,"can be placedvon reverse side). FOR DEPARTMENT USE ONLY ' D APPLICATION ACCEPTED BY_ ----- DATE---- ------- ------------------------------------------- DATE--- - -- �--- - ------,/,---------�._--`-`------- -- -- • -------------------- -- ------------ ---------------- REVIEWEDBY----------------------------------------------------- --------- ----------------------------------------------------------- ------ DATE------------------- BUILDINGPERMIT ISSUED..........=----------------------- ------------------------------------------------------------ ----------------------------=------------- Alterations and/or recommendations-----------_--- -------------------------------------------------------------------------------------------------------- ) -------------- ----- i------------------ _ _____________________________ ~ Date__` .-�',-- ---- FINAL INSPECTION BY:"-_ - _ - - - -- ------------------ - ISAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycornore Street 205 West 4th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.0 O.