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t'VK VI-H(.t USt: ----------------------------------------- --------- _________________________________________________________ APPLICATION FOR'SANITATION PERMIT Permit No. _._l±.4--------------- -------------------- (Complete in Duplicate) .-.--- This Permit Expires 1 Year From Date Issued r Date Issued-.l�..�o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati n is made in complianccewith County Ordinance No. 549. JOB A D1�9D LOCA I�}N__.._.J.�.. -- ----- •I ........... 1-----flc,• 3` R ......� OvagA ,.v--------------- Owner's Name--------- 4 ......................... Phone............-------------------- - Addrasslit.q� nn..lL-----------------------------------------------_--••--•---•-------------------1--.....--•- ------------------. ---•-----•---•-•--.....---•--•-----.......... Contractor's Name---------------------�s�.5�j...4..�S_.,Q.---------e - -- ------- +LC---------••---..-.._. Installation will serve: Residence 59 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..___ Number of bedrooms ___ -. Number of baths __ Lot size _7.7_'x� _�i'X o_�?,!04/V'/,7,q Water Supply: Public system E] Community system C] Private So Depth to Water Table ........ t. iry C�r � Character of soil to a depth of 3 feet: Sand K Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------l No x New Construction: Yes a No ❑ FHA/VA: Yes K. 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_._> .Q_�_._Distance from foundation-------,t!O_ ..Materia El No. of compartments........vZ----- Size � r Liquid depth ••.-...y.......... a acitYifTd4� Disposal Field: Distance from nearest well----/C?Q--Distance from foundation._,;Q�.----Distance to nearest lot 1 Number of lines------•.--..-./------------------Length of each line..............g o _.._.Width of _ , ------- - trench-._.-_-----2!- Type of filter 1 _ Dfl th of filter material-----.--;_?__y___Total length ..-- 93 •••--_.--- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line......._--------- -C-- ❑ Number of pits__.-------------------Lining material-----------------------Size. Diameter----------_-----------Depth---------.._....----------------- Cesspool: Distance from nearest well.................Distance from foundation___.__________.-___.Lining material.....___._..___.........____.___..... ❑ Size: Diameter---••---------------------------------Depth--------- ------------------------------------------Liquid Capacity---•--••-•-----------.--- -gals. Privy: Distance from nearest well----------------------------------------- _-_.-Distance from nearest building___________..._..-______-__._----___-__._. ❑? Distance to nearest lot line-----------------------•----•----------------- Remodelingand/or repairing (describe):----------------------------------------------------------------•--•-----•---------------•--•-------•-------•--•-•-----------•----•---•---------------- ------•----••---------•-----------------------•------------••----••-------------------------------------------------------------------------------•--------• ---- ---••--••----. -----------------•-•------------------- 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, a d rules and egulation of the San Joa ui Local Health District. _.. (Signed)....k._.. - - - ---- --- --- ------- (Owner and/or Contractor) By=-------------------•-----•-- ------ • - --- - - ---------••-•---•-•-----------------------------------(Title)--------'---------------. ..._..-. ---------- (Plot plan, showing size of lot, locatio of syste relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - --- -- -------•------•--_ ------- DATE------------- --- _.-C.'. ... REVIEWEDBY------------------------•--_--------------------- -------------- ----------------------------------------•---------------- DATE-----------.................... BUILDING PERMIT ISSUED---------•------------------------------•-------------_-------------------- DATE. Alterations and/or recommendations------------------- -------------•----------------------•-•-•-•---------••-----•---•------------:...:.- ------------••-------•---------------------------------------------------------•-------------------------------------•-----•---------------------................................................•••--------------- � 2 FINAL INSPECTION BY: Date �--------------• - ---- �....... r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Well Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 RIVISEo 5-59 RM 5-61 ATLAS