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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicated I 3 r. - , -----••--- 8 ._...-fir • _ . .�=�2�°�-- , - r- Date Issued `��-�� i Application .is hereby 'made to the San Joaquin Local Health District for a permit to construct and install"the work herein esc •b9d. This application' is made in compliance 'with County Ordinance No. 549, } . , JOB ADDRESS AND LO ATION _ _ - Owners Name ____ _ _ ____ J`2 --- Address---- x1 -16- a -------------- Phone _ j � f�-`-- - - -1-1-1-1---. -1-1-----------------------------------------------------._...._,...........Contractor's Name__ #-` hone ------------ ------------------------------------------- - P _------------------------------- Installation will serve: Residence.__ Num� Apartment House E] Commercial L] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l___ ber of bedrooms off'._ Number of baths ---I--- Lot size _/3.d �-T --------------_____'_____--_-- Water'Supply:"-Public.,systern 4❑ Commr unity system'[]' Private PP`Depth to-Wafer Table * ft:' i Character of soil to a'Idepth of-3 ,feet. Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑' Clay ❑ Adobe ❑ Hardpan el Previous Application Made: Yes ❑ No.❑ New Construc+ion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: ;. {No septic tank or`cesspool permitted if public sewer is available within 200 feet.} 1 . ® No ante from nearest well-- �D Distance from foundation__/�___-.___Mbter{al Septic Tan Y Do-.-of.compartments____ t Size___ � _�---� ��--------------1-1-1-1--Liquid depth �_�r3'�S tr_�.Ca pacity.��_----1-1-1-1-- � Disposal Field: Number of inearest well -- _,_,-,Distance from foundation_-2o_--____.Distance to nearest lot line---e�...___ p ` ; Length ofeach line,t�l1__�±t-_�-�5'Wia'�th _____________________ 1' Type of filter. Depth of filter maternal To+al.. I ngth /r _Q '----------- - r Distance from f ' Seepage Pit:'�'"" Distance to n crest.well"` _____ _________ oundation____ _......._-.Distance to riearest'lot Ione_____".___.__.". ❑ Number of pits------"--------- ----Lining material-----------------------Size: Diameter-------------- -_------Depth--------------'--------------1-1-1-1-- Cesspool: Distance from, nearest-well------------------- Distance from foundation. ____.Lining material--------------------------------------- El _________________________ ___ ------ � [ � 5�ze: Qiamefe ---1-1-1-1-� - - --- --• Depth-----=--1-1-1-1-- - ----1-1-1-1-- - Ligw d'Capacity------,---- - ..-1;-1-1-1 ----gats. Priv Distance from nearest well-__ Distance from nearest building________ .___ Privy: ------------- ❑ Distance`to•nearesf'lot-line - - -- ------------------.L+.. '`� t -1-1-1-1-- - --- _ _ - ------ _...-..-'s _ -------- V i Remodeling and/or repairing �describe�: _________________________ ____ l -----•- ---- •---------------------------1-1-1-1-- � � �-;�. , i -- , ��-- ____________________ ___________'.___ ._____________________._I_____.__________________.____.._.._ -__._ __ - -1-1-1-1 t�-- ----...-1-1-1-1•- ---- -1-1-1-1-----•�- ---��. ---------------------=----'----------- -1-1-1-1----1-1-1-1-- ---------------------------=--1-1-1-1-- - . ---------•-----------------1-1-1-1-1-1 -1-1----1-1-1-1-- I hereby certify that,1,have-prepared this application-and that the.viork will•be-done:in accordance with San Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District. 1 ' - ! k - ---- ----------------- -- -------- . s I (Signed)- ?__... .-" 1-� ,---- �� { / j --1-1-1-1-- --� � x B �_-------------_..--•--------------------------------- ---------------------------------------- � - r --- Owner a o ctorp and/or,C ntra Y'----1-1-1-1---1-1-1-1---�- t (Title}---------•-1•-1-1-1--1-1-1-1-• ---1-1-1-1-----1-1-1-1--- -- ------�-------1-1-1-1- [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 APPLICATION ACCEPTED BY- = ----------------•----"---- -------- ----•------------ DATE----------- - ---------- ---------- -----" REVIEWED BY-------------------- = ------- DATE---------------- -:;_ Alterations and/or recommendations--------------- - - DATE. -------- 0 '--- I BUILDING PERMIT ISSUED-----------'----------------------- ------ --------------=-== ��-- / rr - -------------------------1-1-1-1-- --1-1-1-1-- ---------------------------...--------...----------•-1-1-1-1--•---. } ----------------------------------------- -------------------------------- --------------- - - --- --------------------------- .__... -----=------------- ----------•-----------•---•------------------I E . . ---- --------1-1-1-1-- ------------ ------------------=----- --- _ ��-- - `=---------- --------- ---- -------- --------- ---------------- . - -1-1-1-1- .--- --- - ---------------------•-------------- ---- -- - -- - - -----------1-1-1-1-- ----------1-1-1-1-• . . . -------------------1-1-1-1-- - -- -1 -1-1-1----1-1-1-1-- ---------1-1-1-1-1-1 -1-1--1-1-1-1-- -1-1-1-1--1-1-1-1-- I --- - - ----1-1-1-1-- , ---1-1-1-1-- FINAL--INSPECTION `----===------------------ ---------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-210 : Revised 1.57 F.P.CO.