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FOR OFFIC USE- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ..,�. ._(.d. ----------- ---------- ------------------- -- J -------------------------- --------- --------- -------- (Complete in Duplicate) fir! . This permit Expires 1 Year From Date Issued Date Issued 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 S ��" - � 1 '�- ----------------- Ls _.__ _ F, Owners Name---�-t-----�:~•---- --•---- •• ----------•-•-- --- = --• •-- -`----------------------------------------------------- --.��........---. . Address.--- ---------- A --------- a ......................................................................... Contractor's Name-----O'btA ------ '-.A--------- = Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A--- Number of bedrooms --a Number of baths ---I.. Lot size -13-0. .0-0 -------------------- Water Supply: Public system 9KCommunity system [I Private ❑ Depth to Water Table _ ft. �I Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay AdC]obe❑ Hardpan Previous Application Made: (If yes,date--------------------) No ET---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.)II „ ` Septic Tank: Distance from nearest well_____�istance from foundation___-_ 2-----lateral__,/? ,c... ........................... No. of compartments-.-..---_____----Size__.. ___3�::Cf_.1�_G-_Liquid depth --------------Capacity_...��•.!' �"�- Disposal Field: Distance from nearest well istanee from`foundation..___��_ .—Distance to no lot line......��Q..� # s �r r Number of lines.._______`______ ___ . "Len tlf 3f��R.iene_ ___ _ ____ __'.'Width of trench________ _ --------------- � g �-_.....--••:.-•----- Type of filter material._. _ C 1 C-___Depth of filter material____._- --------Total Seepage Pit: Distance to nearest well-------------------- from foundation-------------------.Distance to nearest lot line----.._.......... ❑ Number of pits---------'..----------Lining fmaterial-----------------------Size: Diameter-----------------------Depth----------------.-.-------------- 'It Cesspool: Distance from nearest well-----------------;Distance from foundation_-------------------Lining material___________________-....__ ❑ Size: Diameter----- -------------------- --------.-Depth -----------------------------------------------Liquid ...gals. Priv Distance from nearest y; - rest we11------------- ---------------=----------,-Distance.from ,nearest building-------"`--`-----------•---._....------ ❑ Distance to nearest lot line ` ._' .. .x---- ------------------------- f -�•.. ------- Remodeling and/or repairing (describe):_____C �__ '�- '"` -.-- -- •-------/�•{'�`' I t ! y I t _ t—; _ I -.-----• --------------------------•--------'-------------....----•--_.._---•-`-------------------------------------•--------------...-•-----••-•----------------------.._..._----------•---------------- I herebycertify that I have prepared this application and that +he work will be done in accordance with San Joaquin.County ordinances, St laws, and rules and regulations of the San Joaquin Local Health.District. ' .. .. R,. ' r (Signed / -' _. _ _. - '-t - ---•---•--------------------- (Owner and/or Contractor) _4 ..,.. _ •.p. . . A I rile f By ---- ;•----• ------------------------------------ --------------------------------•--•------------------------------------( )--------------------------- ; (Plot plan, showing siie of lot, location of system in relation to wells, buildings, etc., can be placed on reverse'side). FOR DEPARTMENT-USE ONLY `l APPLICATION ACCEPTED BY = - -------------I------------------------ DATE---- -------- REVIEWEDBY :. -------------------- ........... DATE------------------------------ `--------•---._....--------- BUILDING PERMIT ISSUED------------------` --------•--- ---------t----- -------- •----------- ----------------------- DATE-------•------------------------- i-----•- i Alterations and/or rec mmen ations:-_w___ ___.__________ ___________'__._-__...._---:.__=_____.T___. _ __...._.._.._�_� ........ l .. �._ . .... .... ...... ._......--'----•--- - ------- --------- -- -• ------ww- _.»-------- --'-------- - ----- _..- - -------- ---.... 5._�.._. ______ _.__ _ .. � l t _ 1 FINAL INSPECTION BY:.. - --------- Date ��. ,` ifn__Z,.._..- i I SAN JOAQUIN LOCAL HEALTH DISTRICT . S v � 130 South American Street 300'Wut Oak Street , 1144 Sycamore Street ` 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-S9 9M 5-51 ATLAS rr f�