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s FOR OFFICE USE: '• --- ------------ ----J ------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ....................... ; --------------------- (Complete in Duplicate) Date Issued This Permit Exyires'1 Year`From Date Issued_ Application is hereby made,to the San Joaquin Local HealthtDistrrict fora permit to construct and install the work herein described. This application is made inrcompliance with County Ordinance No. 549:`; c r JOB ADDRESS AND .LOCATION ---�� --------- ------------------------------------- .- - ---- � F � / Owner's / �- --- ------------- Phone_ --------------------------- /2 � - _ ---- ;----- -� -_-- - - - - - Address----= - � � f� �{/"r ' ; ------- - ------------•----- •------• --------------------------------- Contractor's Name-------- ----- - -- I -_. /f �-------- Phone._T��.�. �c�� -- , ----------- 4 el Installation:will serve: Residence Apartment House Q ,.Commercial ❑ Trailer Court ❑ ��M//otel Other El Number of living units: __ ._ Number of bedroom Numl e of baths --- Lot size ------- __ Water Supply: Public system ❑ Community system ❑ Ptivatte j;' Depth to Water Table ---- ft. Character of soil,to•a. depth of 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Applicatlon °Made: [If,yet, ate_t___.._.-- 5.____l._No f_New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AN13'3S�PECIFICATIONS: (No septic;tankw cesspool permitted if public sewer'�,.is'available within 200 feet.] A I . : .% Septic`Tank: •--Distance from nearest well-_--------- ----Distance=.from foundation--------------------Material------------_----- _.__-.-_-=_-__--_-. ❑ �IY7 No. of compartme+ts fSize r_ j� Liquid depth - Capacity r Dis oral Field: Distance from nearest well._ i///�-_Distance from foundation_-__420....___.Distance to nearest lot line__X&1_.... ff j EXI �T T'u eber filter material___ - -- Length of4each line.---.-.-..�. " Width of trench--- -7� 'P 3 � / ri- See a e*Ptit: Dance--toriearestwell-----(.� _Ds�ae f fk of Iterfoanda`tilonlot ''Numberf.pits------/.----------Lining material --.Size: Diameter.-_-,1..1��___._Depth____.��,__e_____-.._ (� .,. Cesspool: Distance from nearest well____t--,`,..::Distance from foundation....___- Lining material------------------- ❑ Size: Diameter T..- .Depth --------------------------------------- -------- Liqukd Capacity gals. Privy: Distance4fronearest well_____i -------------- _______ __________________Distance frpm nearest building------------------------------------------ - ❑ r y Distance,to nearest lot line.- ------------ ------- -------------------------------------------------------- --------- --------- ------------------------- ------ # ; 4F � Remod flim and/or repairin .(dos ibe):- ='' l/!�2�-717 .7flle7 .-- -------------------------------------------- ---------- ------------------------------------------ t ., -----------------------------------------------------------------�----------------------------------------- ------ ------------- ----- t ' I hereby certify that, I have preipared this application and that the work will be done in accordance with San Joaquin County ordinances;-State laws,-and*rule d~regulations-of theTSan•Joaquin Local-Health District:'' • - � , (Signed) # _�_ �Yi.� _ �� -_.___._ -------------- ----Owner and/or Contractor By: r ------- ( / ) =-------------- - - -- B "''' � (Title). (Plot plan,!showing size of lot, I ation of system in relation to wells, buildings, etc., can be placed on reverse side). p ; t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY"_ -1._ G--------- --- --- -- ---------------------------------------------------- DATE-------Ji-�J_6G REVIEWEDBY.-------- --------------------------------------------------------------- ---------------------------------- DATE------------------------------------------------------------ BUILDING{PERMIT ISSUED---------------------------------------------------------------------------------- ------- ----- DATE-------------------------------- -------------------------- Alteration ------------------------- It recommendations:------------- -Y- _--------------------------------------------------------------- '.�-'---- ----------- { -------•-------------------------------- ---------------------- -------- ---------------------- ----- ------------------:----- --- / r FINAL INSPECTION BY--------- - - -- ---�s�- -------------- Date---------- �-------------------------------------- S ---- - ---- ------------------------- S J UIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �.P.CC.