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FOR OFFICE USE: --------------------------------------------------------- ---------------------------------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. .._...�. �/ ------------------ -- - - - ---------------- ------ (Complete in Duplicate) Date Issued ��?�=,��5 ------------------ _.__.__________________________ 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 herein described. This application is made in compliance with County Ordinance No. 549. s, -- -�-------- JOB ADDRESS AND LOCATk N__,. - i �i Owner's Name = ��f� ...- -.•-.• Phone------------ Contractor's _.. -------••- u j Address------YE--_!-_ �f" � -------i----...---• •----- '----�'i-� ... Contractor s Name----------------------.......................... ---••-------------------------------••-•--------------- •--------------- Phone---------------- Installation will serve: Residence N__Apartm nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: ___l___ Number of bedrooms _Number of baths -___y- I_ot size .--_1.7-__ } =�----------- a Water Supply: Public system ❑ Community system M Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam J� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date............--------) No New Construction: Yes ❑ ,,�o FHA/VA: Yes ElIkNo� TYPE OF INSTALLATION AND SPECIFICATIONS: CIO (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-- Distance from nearest well_________________Distance from foundation--------------------Material--------------------------------------___.-__---- :: �r1gJ� ��Kjo. of compartments-------------- ----------Size-------------------------------Liquid Rth-------------- ----Capacity--•----�------- Dispo al "Field: Distance from nearest we€l__.�-V_----Distance from foundation..__-7.__c..=_______.Distance to nearest lot��e____i`_____._____ Number of lines---!_.______l Length of each line---� __C�---` _______tWidth of trench-.3.6 Type of filter matenal-->�_k-1 Depth of filter material______ ^_ ____Total length______________ `_�'_CD___'�::_______-- p g - e Q ; ee a e NiPit: Distance to nearest well__________________ Distance from #oundation_________________.Distance to nearest lot line___:', rb I] Number of pits----------------------Lining material----------.----- -;--Size: Diameter........................Depth--------------------_------------ Cesspool: -------_ -- . p Size: Diameter-------------- _______._________________.__Li uicl Capacity '! n Cess ool: Distance'from nearest well_______________ _Distance from foundation----__ _-____ _._ .Linin materia-._.._______�1--- � _ --------- -- ----Distance from nearest building---------------------------- gals. r Privy: Distance from nearest well______________'____" ❑ Distance to nearest lot line_- --------------------------------------------------------------- _ Remodeling and/or repairing (describe) L'LX�Z _ ------•- -�`f�- -------• ----------------------- ----------- -•--------------------------------------------------------------------------------------------------------------oe----------------------------------------------------- ---------- --------- -------------- ---------------------------------------------------------------------•----------------------••-----•----------------------------------------------------------------- --------------- -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ,County ordinances, State laws, and rules and regulations of the SaJoaquin Local Health District. i; (Signed)------------------------ i � _ (rile) - Owner and/or Contractor B ' (Plot plan, showing size of lot, Iocati of system in relation to wells, buildings, etc., can be placed on reverse side). 1, FOR DEPARTMENT USE ONLY li APPLICATION ACCEPTED BY_____________ __ __ ---------------------------------------- DATE ____' �I ��- -------------- - ------------ REVIEWEDBY------------------ ---------- --- ------ --------------------- -------- -•-•-- - -,f nTE-----------------------------------------------'.------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------- 1, ---._ 'A E-:`-- -------------- Alterationsand/or recommendations----------------------------------------------- ---------------------------------- ' --•----------------- ------------••----------•----- ------------ -•----------------------- ------------------------------------------------ ------------------------------------------------------- --------------------------------------------------------------- `I --------------------------------------------------------- -----------------------------------------•--------------------------------------------------------•------------------------------------------------------------------ !. ,il ----------------------------------- --- --- --- -- ,-------------------- ------•------ - ---- --------------------------------------------------------------------------- FINAL INSPECTION BY:.---- _._ -- Date__ y /.. -- ------------------ ----------- i f SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 REVkSM 8-59 3M 3-'r3 F.P.CC.