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FOR OFFICE USE: • APPLICATIONFORFOR SANITATION PERMIT ,. Permit No. _ .l.......3... -------------- --------------- -------------- (Complete in Duplicate) Date Issued _-------------------------------------- This Permit Expires I 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.to JOB ADDRESS ANDLOC--- I N _ s---••F-ld'-------- --- --------- -- - Owner's Name - ~--------•------------ ------------ Phone.. f Address------- 6-:: -----_-f--�-.-.�. Contractor's Name_ - ._T'�_'r._'`l'" .: Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... Number of bedrooms --L--. Number of baths _/_-.- Lot size 4,49X-4910:�,---•------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table tr'Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe e-Hardpan ❑ Previous Application Made: (If yes,date----------- ----- --) No P!�'�New Construction: Yes ❑ No Pr 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------------------ --------------------- No. ..___--. ----No. of compartments -----------------------Size------ ----------- -------1-----Liquid depth--------------------------Capacity---------- Disposal Field: Distance from nearest well_- -±- ---Distance from foundation---. ._._..Distance to nearest lot Number of lines...____.....- _-_-_ Length of each lire-.- �_ Widtkl of trench_ate ---------------------------- g d�---- . Type of filter material .. .Depth of filter material---,/._ ._Total length__...��----_.____________________ Seepage Pit: Distant e �o nearest well--------- -'-------Distance f fou dation_.. _f�is Distance to nearest I t I�n�--s�-~..----- Depth. �---------------- �� Number.of Pits-----�-----` --Lining material-. ---.-(��- ---Size: Diameter_- -' ------_----- -- Cesspool: Distance from nearest well-----------------Distance from foundation---_--------------- Lining material--.-_-__---------------------------- [D Size: Diameter--------------- -------- Dept h-----------------------------------.----------------Liquid Capacity---------------------- gals. Privy: Distance from nearest ell-------------------------------------------------Distance from nearest building-------------.--------------------------- F1 --.----.._-----_-__._.. -❑ Distance to nearest lot lire-------- -------------- ----------------------------------------------------- --------- ... 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 regulations of the San Joaquin ocai Health District. LContractor - ------- --- ---- --------- (Signed) �� 1 ---------------------------------- ------•------------------•--------------------------- ------ --- -� - -----------(Title)- F � " ---- ------------- - -- i(Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). .r OR DEPARTMENT USE ONLY Y ' ��s APPLICATIONACCEPTED BY---------- ------------ - - -------------- ---------------------------------------- DATE------f ��'------------------------------- REVIEWED BY---------------------------------- - ---- - -- - -------------- ------------------------------------------------------ DATE-------- -----------•--•------------------------------------ BUILDINGPERMIT ISSUED------- -- ---------------------------- -------------------------------- DATE---------------------------------------- ------ ------------- Alterations and/or recommendatiotrs:._.____.._. _. p r s. Q►��. -------- --------- ----------- �-- - air----- Al7�( f/ ... r/�` * r -- r�-��--c�---- --ccs,-�i - --- - �� ----- �/- ..... ........................... -------------- ---------------------- ----- ---------------- --------- � ry 1'4 .. ._...-_- ----r_.---------------- ------------------- ..e._' - P---a-------------1- --------------------- aP----4--r----ti- ------------------------------------------ . f � --- b �-r ` ---- � rma FINALINSPECTION BY--------------------------- - - --- ---- ----------- Date.------ --------------- ----------------------------- cUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 1 X124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.