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FOR OFFICE USE: --------------------- ------- ---------------------- - f APPLICATION FOR SANITATION PERMIT Permit No. /. .... ..i ------------------------------------------------------- (Complete in Duplicate) Date Issued --- --------------------------------------------------------_ This Permit Expires i Year From Date Issued Applica#ion 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. 0(0f 07v— f. , Z-1 2��t?- n)= H ir'&k WK g ° JOB ADDRESS AND OCA ION--- sc�u_. 1 �"�"' G ' - ------ ------------------- 'Al �!/ /w •--•-••---- -- ------------------------ Phone Owner's Name , rC- ; . "-- ------------------- Address = R� Contractor's Name. J = ----------------------------------- ------------ -`� --- � `" •------------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ k Number of living units: ___L. Number of bedrooms -;L. Number of baths ----/.. Lot size __�,A/Le��---_--------------------- Water Supply: PublicIsystem 171 Community system ❑ Private 25/ Depth to Water Table _.._.___ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam g]"' Clay Loam [IClay E] Adobe E] Hardpan ❑ I Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 ik ,(No septic tank or cesspool permitted if public sewer is available within 200 feet. Se f ank: Dis#ante ------ ista ce t+o No. of c m rtm r5 f i id --•---• f----------Capacity-- ---- -••- �I i ��________..Distanca to neares of line �............. --• ---�--'-----------------•---•--- Disposeld: Distance from nearest well�_._w�_____.__.Distance from foundation._____ .._ Number of lines____/---------_-------------------Length of each line__��_____.__.____ Width of #ranch-_ terial Type of filter„material:_._/}.�C�,- - Depth of filter foundation��`f___.._.Distancengohneares�t line_______________ Seepage Pit: -Distance to nearest well__________________ Distance from ❑ Nu'mber of�pits----------------------LinjDg�mateeriial--.---- ------...,IIII.Size: Diameter--------------------- Depth--------------------------------- Cesspool- Distance from nearest.wellli___-------------Distance from foundation--------------------Lining material------------------..________•-_--___ ❑ Size: Diameter------------------------ i---------Depth---------------------------------------------------_Liquid Capacity-------• ----------•----•--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line-------------------------------------------------------------•-•--------•---•--------------------------•---------•--------•--•---------------- Remodelingand/or repairing (describe):---------------------- -------------- --------------------------------------•----------------•--•----•--•-----------•-----------------------•------------ -� ---------•-----------------------•-----------•-----------------------------------•----------••--•------------------------ ------•--------•- ---------------------•-••---•--------------------------------------- -----------••----------- ------------------._...------------------•-------------------------------------------------- ------ hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules a d regulations of the San Jo quip Local Health District. (Signed). !�x-c - _.----- ~--tewnw,, and/or Contractor) ld • ._. ...... mac -------------------- (Title) Y•. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --------------------- DATE-.---/ -� ---------------------------'--- _ _ -•-------------- ----------- REVIEWEDBY-----------•-------------------- ' -- - -- --------------------------------•--- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ----------••-----------------------•- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------- -------------------------------------------------•-------------•---------------•----• -------------------------- -•••..............•--...._.__._..----. ------------------..._..--.•------------------- -- --------- ----------------------------------- ^-----r-...--- ---__--------------------------------------------------------------------------------------------------------------'------- 00, FINALINSPECTION BY- -- -- - ---- ---- --- Date--------------------------------- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americari Street 300 West Oak Street 134 Sycamore Street 905 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 ZM 5-62 ATLAS Id