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FOR OFFICE US-E; -----------_----_-------------------------------_____---- r _______ _________________________.._..__.__-__- ------ APPLICATION FOR SANITATION PERMIT Permit No. ------ ---------------------------------- ---------- - -- (Complete in Duplicate) ------------_-------. 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 com fiance with County Ordinance No. 549. Zp?� —G�p d I j t{3 a D�@ m,�`Tl-(.fir/e�.J� ,v SID E JOB ADDRESS AND LOC ON---------------- -------- _1__ Q.Aj------- - --------� -- E`i-D _ Q-C �S Owner's Name--------------------- ----------- - N Address----------------- - TTa_---- ---1--------•------Box..------------ Contractor's Name-------- w- m-K-----••-----------------------•--------- t----------- '----------------------------------------------------- Phone------------------------- --------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court E]—Motel ❑ Other ❑ Number of living units: -/--_ Number of bedrooms Number of baths __/___ Lot size ___ _F---?'0C _�_______________________ 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 ❑ ay ❑ Adobe ❑ Hardpan ❑ i Previous_Application Made:_llf,yes,-date__.__'___..____._) No �ew Construction_ Yes No ❑- FHA/VA:,Yes ❑ No �— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ____Distance fro2m foundation--------------------Material-.--- _ -WOO-� No. of compartments-------------------------- x_ __, Liquid depth.__ SizeZ= CapacitY � �s Dis osal Field: Distance from nearest well O__-_Distance from foundation_____• - p �!�______.Distance to nearest lot line_________________ !'t D��G Number of lines_____________/-______--_.___-...__Length of each line___._____.JF_�0______-__-_.Width of trench_-_-__ __-____..___.__ nO !`r f Type of filter material___- C} -Depth of filter material___-._ - - Total length__________________ SQ_________ Seepage Pit: Distance to nearest well___-------------------Distance from foundation___________________ Distance to nearest lot line___-.___._____ '^' ❑ Number of pits----------------------Lining material---------------------- Size: Diameter.----------------------Depth---------------------------------� Cesspool: Distance from nearest well_________________Distance from foundation--------------.-----Lining material„_____.._._.._____________--_______ O ❑ Size: Diameter----------------- --------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. I Privy: Distance from nearest well.-------------------------------_----------------Distance from nearest building _#____________.__.__._-----_--__-._... ❑ Distance to nearest lot line-------- ------------------------------------------------------------ Remodeling and/or repairing (describe)=------------------------------------------------------------------------------------------- --------- -+Q6' ' - ----------------------- -- -------------------------------------------7 w - e i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ofid r es and reguI do -'of the San Joaquin Local'Health District. a � s 7 -f T ;{Si9neYd} --- `=T = ---------------;-'----------------- `- ---- -------- ---- --- ---- ----- =--------------------- -(Owner and/or.Contractor)----,-.— By: ontractor)=,. jBY:---------- -=------------------------------------------- --- Title (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 y APPLICATION ACCEPTED BY R-,- ---------------------------------------- DATE------- REVIEWEDBY------------------------------------ -------------- -------------------------------------------------------------------------- DATE �? BUILDINGPERMIT ISSUED------------- --- ------------------------------------ ------------------------------ ---------------- DATE------------------------------ Alterations and/orrecommendat ions------------------------------------ -------- - ----------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------ - ----------------------------------------------•------------------------------------------------------------------------------------------------ ---------------------------------------------- -- -------------------- ------------------------------------------------------ ------------------ -------------------- ---------------------------------------------------- ------ -- ------------------------------------------------------------------------------------------------------------------- - ------ ----- ---------------- - --- ---------------------------------------------------------------------------------------------------------- ---------- FINAL INSPEC Date:----------- `-/ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r _ Lodi,California Stockton,California Manteca,California Tracy,California