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FOR OFFICE USE: I . I,....._..__.s-............-------------- ------ ------ APPLICATION FOR SANITATION PERMIT Permit r+o ....... ....... -•--~---------- Com Tete-in Duplicate) f { P Date Issued ------------------------------------------__-------------- This Permit Expires 1 Year From Date Issued' "' Application is hereby made to the San Joaquin Foca€ Health District for a permit to constr ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. + Iffr I JOB ADDRESS AND LOC TION----_ __ .. ---- --_ I -----------------^-------- Owner's Name---------- -- - ---- - Phone------------------------------- Address----------------------------- -----------------------------Address-------------------•---•----- --- -----••-•...s5.tr ' Contractor's Name 1� _irk..['1--------- ---_------�.N,� ._ //U Ci ------------ ------ Phone_�fj0j�le&-Q /- - -� Installation will-serve: Residence ' Apartment House Commercial ❑ Trailer Court ❑ Motel E❑ Other ❑ Number of living units: I---- Number of bedrooms Number of baths__j---- Lot size _75:7X -l_Qr---- ------------------------ Water Supply: Public system A, 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-........_..__-_- ) No D . New Construction: Yes ❑ No K FHA/VA: Yes ❑ No K TYPE OF INSTALLATION'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1, Septic Tank- Distance from nearest welLlJA90A!5_._Distance from foundation--------------------Material ------------...__:_.-.---__...____-_------ ❑ ,r l5 L11 No. of compartments------------- -- - ---Size-------------------- -----------Liquid depth------- .......Capacity---------------------- Disposal Field: Distance from,nearest well-----------------Distance from-foundation-...----------------Distance to nearest lot line-_--__---_-_•-_ ❑,1(tc,_hA) Number of lines ----------------------------------Length of each line-- ------------.-.-----------.Width of_french----_`.------------.-----------.---- * Type of filter material----.___----------------Depth of filter material____-----..------------ otal length-------.----_--...._-.-_-_-------__.----_ Seepage Pit: Distance to nearest welL/U6LU _-_Distance "omundatjo"__7_b: -.--._.Distance to nearest lot line__.z _--- cr �Number of pits_f _l7tG(f� Lining material. Sae: Diameter__- 3_..__..._._Depth_.2.�-------------------- Cesspool: Distance from nearest well ________________Distance from foundation................. ..Lining material-____--------------.--_.___.----_----. ❑ Size: Diameter- -- ---------- --- --_.Depth----------------------------- - ----------------Liquid Capacity-----------------------------gals. I Privy: Distance from nearest well-----------------I-_._.._-_ ..-..__...._... ._Distance from nearest building--------------------------------- ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):----.. .. o - ---------------- ------- ---------------------------------------------------------------------------------------------------------------------------------------------------•------------------- ------ ........ I hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an : r les and regulations of the San Joaquin Local Health District. (Signed}---------------------- - i4' /v. {Owner and/or Contractor} -. r --- By-------------------------------��cl��---- f-----42ells, ------- --------- ------ (Title}. .........----- ----.... (Plot plan, showing size of lot, location of system in relation buildings, etc., can be pl ced on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ��,r ,Gu . . ------ ------------- -------------- DATE/Q..-f ------------------------- REVIEWEDBY ------------------------------------------- ---------------------- -------- ------- -------------------------------------- DATE--.. ... BUILDING PERMIT ISSUED------------ --------- - -------------------- -- DATE..--------------------------- ----- Alterations and/or recommendations:-.-. _ -------------- r----- --- -_ - --- -.----- ------ ------ - rR, .._�Cr�...,/. ------- -------- ------- ---------- - .R'; roil' f i • d .' 'w ---------------------- - y ---------------------------- FINAL INSPECTION BY:.. - ....... .................... Date--1,?. ," - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press