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FOR OFFICE USE: 1i .i -----------------------'---------- ------ -, II APPLICATION -FOR -SANITATION PERMIT Permit No. _d` . ----- - ----- (Complete in Duplicate) ---- ----- ------------------- --_ This Permit Ex ires 1 Year From Date Issued 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 cl�mpliance with County Ordinance No. 549. , fi JOB ADDRESS AND LOC�ApTION------� - ----__��___.-----��r-- -- -- --�'�--1�-------------•--------------- -----•------- Owner's Name '' •-/,�� =:: �J/'�_�t ---- „ -_ Phone_' �.7C _S r ------- Address------------• -.-- __-� --------- ------------- ----- - ATG- �J Contractor's Name____________ ____ / /L�� .-'----.,,�-rls- --_----_----- Phone.` _., f Installation will serve: Residence [J-"Apartment House ❑ Commercial E]*"Trailer Court ❑ Motel ❑ Other [] Number of living units Number of bedrooms.. Number,of baths -------- Lot size __ .1� _,��?_______________________________ t cnlNater Supply: Public system �Communify sys'tem '❑ Private ❑ Depth to Water Table ft. ,r ,�. '•ti�- Character of soil to a depth iof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,g Clay ❑ Adobe ❑ Hardpan ❑ '. Previous Application Made: '{If.yes,date--------- No F!Cj� New Construction: Yes ❑ No ® FHA/VA: 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_________________Distance from foundation--------------------Material------------------------------------------------ . El No. of compartments----- - -----------------Size--------------------------------Liquid depth-------------------- Capacity-------------------� Disposal Field: Distance;from nearest well_ �-'~.._Distance from foundation./Q__ •__.Distance to nearest lot line_______--- Number of lines-----/___________ __ ___________Length of each line--_- .__`_-_---_-.---Width of trench._._ �_'..__---____--- Biter material__-S Type of ;. ��.._-Depth of filter mater�al___. ___Total length--------�-r?__ -------------------- (A Seepage Pit: Distance 'to nearest well------------ ---------Distance from foundation__!11___�___.Distance to nearest lot line----------------- h (� ti Number f pits--------- ___.-------Liming.material-,1BC .Size: Diameter____ '_'______Depth___ a��__._________ '�« 9 ' Cesspool: Distance!�frcm nearest well__A4F_:__!_-_-,Distance from foundation__________________.Lining material-------------------------------------- Si _____________________________________ ❑ Size: Diameter----------------=--- ----------- .Depth------------------------- ----------------Liquid Capacity----------------------------gals. Privy:- Mstance�from nearest well---------------------------------- ._.._._-_.-Distance from nearest building------------------------------.-._........ . ❑ Distance.,to nearest lot li f---------- ----- ------------------------•------------------------------------------------- - ------ Remodeling and/or repairing (describe):_, ---- s_ -G __ s ,1ti-T �/ .1�'______ _, f-Ems____._____ t I -ii y { II {. I hereby certify that I have prepared this application and that'.the work will be done in accordance with San Joaquin County ordinances, State jigffs-aiuds rules and regulations oc he oaquin Local Health District. (Signed)------------------------ -+� /Y-Zj -� (O r a /or Contractor) ,. " - J By::------------- - g i -- - --------- ----------------- ------------------- (Title) r (Plot plan, showing size,of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY si L 2 7 �G APPLICATION ACCEPTED BY .�.- --- --'-'----- - --- -- -'--------'------"{ ------------------"- - - - DATE - ------------------------ -----'----------------------- REVIEWED BY--------------I------ !( t ------ DATE-------- ------------- -- BUILDING PERMIT ISSUED. ............. ..------------------ f/��] DATE Alterations and/or recommendations: - - ' --------- ---------- ----------•----"------------------------ ii Il ii' r• tr s s --------------------- ---------- '-----..... ------------------- --------....... — -----------' - --------------------- ------- -I----------- ------------ ----------' Q FINAL INSPECTION BY: il - =-- ----C�._.--------------------------- Date---------------- -- G ' ---- ---!l " -------------------------- �./ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California j! Lodi,California Manteca, California Tracy,California F.P.0 O.