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FOR OFFICE USE: _.._ s - �,._r - _� __--- APPLICATION FOR SANITATION PERMIT Permi+ No. ._ .II_-� ----------- --- ---- -- ------ --- ---- - --------------- (Complete in Duplicate Date Issued ------------------------------------- -------------- - -- This Permit Expires 1 Year From Date Issued -- z 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 -� 2 t •r' '/' - - Owner's Name------0_0414 Phone--- -------------------------------- ��?�:�j '� a - ---------------- Address---------------------- Contractor`s Name ' V`= -------------- Phone----------------------------------• Installation will serve: Residence V�partment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other ❑ Number of living units: Nu ber of bedrooms __�_ Number of baths Lot size ---G -- L _G _RWM Water Supply: Public system VCommunity system ❑ Private ❑ Depth to Wafer Table --- ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay [-] Adobe ardpan ❑ Previous Application Made: (If yes,date----------------- --) No D--"New 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.) Septic ank: Distance from nearest.well'_.._,"- :-__Distance from foundation-'/0---1----Material___ 11�� GG�� p �: �{f ---------Liquid depth----- ��----------CapacitY--- �`��------ No. of cam artments_____.___-- Size_-�_--� _ �1 �//� r � �! }------- 9 . = �l ------ --••- Disposal field: Distance from nearest well__--- _ -Distance from foundation_____ _____ _._._.Distance to nearest lot line_ Number of lines-----------�.�.�'._f Length of each line________ _______1� �__.Width of trenc `! r ;________-____ ' Type of filter mafieriaL___ �I.________ Depth of filter materiaE____. Total length_______ _____ _____ _ _ .______ -- Seepa Pit: Distance to nearest well________`..__------Distance rom foundation-----/D...____.Distance to nearest lotjjn�__. Number of its_-_- ---Linin material___ __ Q__...�.__.Size: Diameter_____ _ _._._. � i 4 P g � - ---.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------------------------------------------- ElDistance to nearest lot line---------------------------------- ---------- - ----------------------- ------------ -------------------------------------------------------- Remodeling and/or repairing (describe): � � t=---- •� -��.-t . ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ----- ------------- --------- r I hereby certify that I have prepared this application and that +he work will be alone in accordance with San Joaquin County; ordinances, State-I ws, Ind rules regula+ions of the San Joaquin Local Health District. (Signed------------- i---- --�- n -(Owner and/or Contractor) , BY:------------------------------------ i- ------------------------------------- ------------- -- --------- (Plot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse si e). i �v FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY------- r�2 - DATE � ��--------------- ----------- REVIEWED BY------------------------- -- �. --------------- --------- -----------------------� ------- ----- -- ----- -- - -- -=--- DATE---- -�- - ----• •---- - -- -- ----------------------------- BUILDING PERMIT ISSUED----------------------------------------- ----------------=----------------------- DATE--------- ----------'-------- - ---------------- �qt Alterations and/or re c rnmendations:___ ,..._7h.�h.._ _f + — -.�-«�` :1 __.___ __=__ _ �' -------- -_-----� 1------- ------------- -------------=------------------------ ----,-------------- --------- -------------------- ---------- ----•------------------------------------------- ------------------ ------------------------------------------------------- ------------------------------------------------------ Y-- > �v FINAL INSPECTION BY:. �-- Date _&Z�h._ SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. r