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FOR OFFICE USE; r 3 2APPLICATION FOR SANITATION PERMIT Permit No. - - - z ------ ------------------I------- ---- -------- (Complete in Duplicate) Date Issued ---_----_--------------------------------------------- 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. JOB ADDRESS AND LOCATION / - irf �� -�-'------'=------------------------------------------------ Owner's Name Phone = ----------------- -------- -------- Address---------�� ' ---------------------------------- Address Contractor's Name ` { --- ------------ `--2 r Phone. ] f------- ---- Installation will serve: Residence .. impartment House;❑ Commercial F] Trailer.. Court [3M3tel ❑ Other E] { Number of living unify: __/._ Number of bedrooms &-- _ Number of baths se__ Lot size A__ __oo-_ Z5---�__.___________.___- l+ Water Supply: Public system Community system E] Private E] Depth to Water Table ;00ft Character of soil to a dep+ht of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay;Loam ❑ Clay❑) Adobe 0-`11'ardpan ❑ Previous Application Made:(If yes,date--------------------) No Me---New Construction: Yes ❑ No [�FHA/VA: Yes ❑ No -- TYPE OF INSTALLATION AND..-SPECIFICATIONS: f {No septic tank or cesspool permitted if public sewer is available within 200 fee+.) { i r vDistance from foundation_:_,t________________Material-___.____...___.._.__-_:-____-____.____.____- Septic� � k.`� Not of compartments---well----------------- --- ------- ---Size-------------------------- Liquid depth--------------;F ----Capacity----------------------- Disposal ----------------------Dis osal i?, : IDista ee frolines nearest well.:........... . Distance from”foundation-----------------._-Distance to nearest lot line________________ Z �' � �' `' Length of each line----------------------- _ ____.Widtli of trench----------- . _ .. ________ � 9 Type of1filter material__.._.___---------- ___Depth of filter material------- -- ---- --Total length______________________-_______-________ Seepage Pit: Distance to nearest wefi___.____- --------Distance from fou datin�rrest lyit lin�_f/�__�_ ®!'~ Number`of.pits....,r._-.__-_____.Lining material- /__ i5izes,'Di��er=.-D}s epth__ __ _____________________ a Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining - material____._._..._______..______-_____ ___ ❑ Size: Diameter--------------------------------------De th--------------- it --_---Li Liquid Capacity gals. --------------------- Privy: :--------------- Privy: . Distance from nearest well _______________.________.____.`.,_.Distance from nearest building___-______._________._______------_-_.._. ❑ Distance to nearest lot line---------- ._ r ___ - .____..?---------------------------------------_-------- ----------------------------------------- Remodeling and/or repairing (describe)-- -------------------------------------------------------- -------------------------------------------------- - I -------------------•--------------------------------------------- ' `------------------------------------ € + I 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 r ulations of the San Joaquin Local Health District. I� (Signed) %system (Or Contractor) { 5 ]---------------------- --- - --- - BY= {Ttle) (plot plan, showing size of lot, loch+ir a+ion to wells, buildings, etc., can be planed on reverse side]. S � � i '� OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... --CeJ�---------------------------- DATE z� G '# REVIEWEDBY----- ------------------------------- ------------ ------------------------------- ------------------------------------------ DATE------------------------------------------- --------:_--- BOILDINGPERMIT ISSUED.-------------------------------------------------------------------------------•-------------------_ DATE------------------------------- ----------------------------- Alterations and/or recommendatio s: ------------------ -------- ------------------------------------------------------------------------------- '. P'{ /-s a - -trl- -- ------------------------- ------•----------------------------------------------------------- -- -- - -------------------------- -- r--- ------------ ---- --------------------- ------ C 2 C� Date------------e�_e� ---------------------------•---- FINAL INSPECTION BY------------------------- - ' SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Mazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi,California Manteca,California Tracy,California