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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.- -- ------ -- ------------ --------------- (Complete in Duplicate) Date Issued .______f._Y.__b-� -------------!----------------------_-----------------_... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. This,,dpplication is made in compliance with County Ordinance No. 549. JOB'ADDRESS AND LOCATIONA- Q4 �= wner's Name __ 1� -La - ---- --------------- --- ---------- Phone------------------------------------ 0 Address-------- = - -------r_� -- --------------------------------------------- ------------------------ ------------------------------------------- '--•-----------•-------- Phonel-----------------•------...------- Cotractor's Name__________ _ _ ? Installation will serve: Residence [ Apartment House ❑ ..Commercial ❑ Trailer Court ❑ Motel ❑ . Other ❑ Number of living units: ___�__ Number of bedrooms..-- Number f baths -__ Lot size ____-44_4,_1_J _____________ _____ Water Supply: Public system4 Commuriity"system ❑� Private Depth to-Water Table _ w Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: (If yes,date___---_----_--------) No ❑ New Construction: Yes ❑ No ❑ FHA/,UA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------------- from foundation_-----------------Material------------i--------js-------------------------- ❑ No. of compartments----'---------------- ---?Size--- -------•--------------- Liquid depth 1�apacitY Dispos Field: Distance from nearest well_...,'[ -.:.,.Distance from foundation___- .Q___.__.___Distance to neafrest lot liine_5____--_---- Number•of lines----------k i- -------- 'Length of each line---- ---G.Q_ -----------Width of trench------- Type of.filtertmatersaln_._ _ -` -IDepth of filter material----f_f. ,_______Total length-----!__0_0-------------------------- Seepage Pit: Distance to nearest well____________________eDistance from foundation___-________....___.Distance to ne I,rest lot line----------------- ❑ Number of pits-------------------- Lining material---:------------------Size: Diameter----------------- Depth--------------------------------- : I Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material:_._.._____._.._____-______--------__ ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gaL9 Privy: Distance from nearest well----------------_------------------------------__Distance from nearest building----,-__-..__`_________--.-_-.__...__--_. ❑ Distance to nearest lot line---------------------- ------------------------- ----------------_----------------------------------- j- �' Remodeling and/or repairing (describ ) _ --------------------------------- ------------------(--•---I---•-------•---------------- 1112� --------- ' ` v= ------------------------------10 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-- ------------------------------------ ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with:San Joaquin County ordinances, State I s and rules and regulations of the San Joaquin Local Health District. , l ----------------------------------------------------- nd/or Contractor) (Signed). ------ ------ ------ By--- -- ----- ------a----------- --- --- -- -----------------------------------------------(Title)------------------- ----'`I= (Plot plan, A 'g size of lot, location o system n relation to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY 4. APPLICATION ACCEPTED BY- -- -------- -------^ ------------------------------------------ DATE - ;4y 6 �- ip REVIEWEDBY----- ----------------------------------- -- ------------------------------------------------------------------------------- DATE ------------------------------------------------------ I' BUILDINGPERMIT ISSUED--------------------------------------------------------------—------------------------------------._ DATE =------------------------------------ Alterationsand/or recommendations-------------------------- --------------------------------------------------------------------------------------------n ------------------------------------ --------------------- IM------------------------------------- --------------------------------------------- -------•-•----------•--•-------------- ----I---------------------------------------------------------------------------------------------- -------- --------------------------_- .IM ----- - ---------•------ --------------------- ----------------------- -------------------------------------------•---------------------------------------------------- --------------------- ------------------------------------------------- --------------------------------------- --------------------- ------------------------------- --------•--------- --------- •--------:I�,. -------------- FINAL INSPECTION BY Qate---7—� -`� I ----------- ------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED a_S9 3M 3•163 ".Co.