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a ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No...... -------------- I -------- --- -- -------------------------- (Complete in Duplicate) ------------------ -------------------------------`----- This Permit Ex ires"I Year From Datd1ssued - 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. _ ( 40 _f y JOB ADDRESS'AND'LOCATION. _ -,- ,E' -e----��_ - -ate--- •-�-1�........ ---4�1 W---- -- Owner's Name ---- _ �.___ C ta_� 1_�,�---------------------- -------------------------- ---------------------------- Phone ---------------•--••-- Address-------- Contractor's Name ---------- /�T._f4 '----------------------- , - a.-------------------------------••---------------...------_....------- Phone ........................ Installation will serve: Residenice ErApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms S--- Number•of baths / --•� Lot size-�_-Q��"4�✓-•r-•---------------------- 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 ["Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes, date---------j No [ New Construction: Yes P—No ❑ FHA/VA: Yes R;-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer isavailablewithin 290<feet.) Septic' Tank: Distance' from nearest well---- 49P------ Distance from foundation ----- 1Q_.. ---- Material --- [��' No, of com artments-_ r -----------------Sizea��!X12206W.Tiquid depth_---/ Capacity--- !I 11 .II' p o � _ - Disposal Field: Distance from nearest well _......Distance from foundation_--/P- ---.Distance to nearest lot line `--_ - :, . ®� Numberiof lines___.---__�___-_--_-___ Length of each line%�'�--_AO-'.___..Width of french---,r �'�'_.______._ Type of ,.filter material �, ---Depth of filter maferial_l�!�-----.--_-Total length-.-- - ___ __________________ Seepage Pif: Distance to nearest well---/� J _ 'i i .�-�---.-----Distance from foundation _�,P _----.Distance-to _nearest hof hne:l?___..--__ ( Number of pits_.- ----------t-__Lining mat erial__-Size : Diameter--'�'- p i De th-eA-- ------ Cesspool:. Disfance� from nearest well-----=----------'Distance from foundation.- ... - .Lining material..-- -------------- ❑ ' Srzo:•Diameter------- `De fh' �� _ ,. w_I .� - p ,. Liquid Capacity --------------gals. Privy: Distance from.nearest..well=-___-..`__Distance from nearest -building ---------------------- _------------------- ❑ Distance" to nearestJot line------ __-------_------------------- - - - - -- - t ., i Remodeling and/or repairing (describe):--------- _ /� -------------------- { ----------------------------- I ------------------ 6 -----------------------------------------------------------------`-- -• f 1 I I i , -= ` I hereb certif fhaf I have pp I Y Y prepared- fhis a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulAons of the San Joaquin Local Health District. (Signed)------------ ---- B --�_------------ ---------- -- 9ter-mv#or Contractor) - (Title)--- !------- ..... (Plot plan, showing size of lot, location of syst in relation to wells, buildings,.etc., canibe placed on reverse side). iJ FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY_----__.-.__ -- ` DATE..--�®- S F REVIEWED BY----------- �� j DATE------------- ---------------------- -----•-- ------ BUILDING PERMIT ISSUED--b----------------•--------------- ------------------------------- I <� - -=-------------- DATE-------------------- --`--- Alterations and or recommendations:-..___- -----_ - -----•---------- •------- ------ - • ••---- -- -----•-•-- I..-- o- -- --- r�. o�----------------------------------------------------------- --- - ------------ - -- r ---------- ------------ ----------------- V ------ --------------------------------- - - •----_-'----------'------------------•_.- ------ ------ FINAL INSPECTION BY: _____-- -- ' ___-- - - Date -........ •-----rQ �L� �� ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Cti 124 Sycamore,Street 205 West 9th Street Stockton, California '+ Lodi, California ' -IN Maniecci, Cellfo}ofia Tracy, California E9-9 gEVISEC 6-59 P.P.0 C. SM 6.60