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FOR OFFICE USE: Lt y ---------------------------------- ..-.. --- - z z_u ! rJ APPLICATION FOR SANITATION PERMIT U%° - - . -- -------1C'%-.d------------------- (Complete in Duplicate) . - Date issued ...ft--•-•---•--- ---------- ---- --------- ------- "' v 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- 49. r -• ----------.--------- JOB ADDRESS AN O.Ct°.TION ✓�� .. -------- Owner's Name=--. Phone --_-----_------------ Owner's Name ------------_------ Addresss 1 -----------------------------------------. ..._.. � , r ' _► c ------- Phone ' f� D Contractor's Name.-----•------------------ - -- ------ ----------------. ..--------....----•------•- •- Installation will serve: Residence Apartment House ❑ Commercial, ❑ Trailer Court ❑ Motel ❑ Other ❑ l l '4 Number of living-units::__/ N umber of bedrooms _ Number of baths ._ _..-_ Lot size -_-� ._ ._./----------•-----------•- Water Supply: Public 'system [ +Community system:❑ Private ❑ Depth to Water Table;%! ft. } Adobe,_ /Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ .Clay ❑ LzJ" ❑ Previous Application Made: {if yes, s ate-------------------] ' �o ❑ New Construction: Yes ❑ No [i��FHA/VA: Yes ❑ No ❑ d - TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tank: Notance of comparfrom tearest well__--------------Distance from foundation--------------------Material------------------------------------------------- menu Size-------------------------------Liquid depth-------------------------Capacity---•----------:-------- Disposa"I Field: Distance from nearest well------------------Distance from foundation------------------_Distance to nearest lot line.------_----_---- ❑ Number of lines-------------------------------- Length of each line------------------------------Width of trench-------.------.--------------------- Type of filter material------------------------- of filter material----------------------Total length-------------.-*_...------'--------�---- \ Seepage Pit: Distance to. nearest well-----Distant om foundation-- 4--_.-___.Distant? to nearest lot line__S____.---- �,� Number of pits-------- ----------Lining material_ l3� ----Size:-Diameter____-c --"-------Depth_-.---- a-•------•--•---- (� Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_-_______._____.._____-.____________ [ ----Dep th------------------------------•---------------------Liquid Capacity ❑ Size: Diameter--------------------------- = gals. - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-----.------------•---------- .■. _ - ----------------------- Distance to nearest lot line------------------------ - -------------------------------------------•-----------•------------- Remodeling and/or repairing (descnbe):---------------------------------------------------------------------.-----•-•----------------------- ----------------•------------------------ ------------------------•---------------------"--------------------•--------"---------;-----••------.---------------- ---------- --------------=------------------------------------•---------- + I ------ -•-------•------------------------------------------=------ ----- ---------------------------•--•-------------------------------------------•------... th San Joaquin County I,hereby certify that I have prepared this application and that the work will be done in accordance wi ordinances, Stat laws,'and rules and r gulations of +he San Joaquin Local Health District. caner and/or Contractor} Si ned ----- ----- ------ --------- ----- LZL; ------- ---- ------ Tit {Plot plan, showing size of lot, location of system in relation t e s, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y------- i - •/ _ . :} -'- ;---------------------. DAT ? T- 2j_� { REVIEWED BY-------- '------ - '' ---------------------------------------- -------------------- - DATE-------- • • --------- ----------------------=----------- BUILDING PERMIT ISSUED_;�=------------------------------------------------------------------------- r ----- z DATE-------------- ---- -------- Alterations and/or recommendations: 3 -� •'?5, -- �, ��-' ------------------------ FINAL INSPECTION BY:._ - "l~_.--_��'—`--------------- --------- Date-.--.-... =--- 2� r------------ ----------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �L E8.9 AEVIBEA e•59 F.P.0 o.2M 6.6P f� r � f