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FOR OFFICE USE: Z_ ------------------------------ --------- Permit No. - ------------- APPLICATION FOR SANITATION PERMIT -- ------------------------ --- (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 Ordinan No. 549. _ ------------- JOB ADDRESS AN LOCATION--------- ----- r ------ ----- Phone--•------•-------------•------------ Owner s Name ---- - - ------ ------•--94i - ------ �f - 94 � ------------------------------------•-------•----------------------- ------------------------ Address ---------C��--`-- r ----------- - - Contractor`s Name --- I ontration will serve- Residence ❑ Apartment.House ❑ Commercial ❑ TraUler, , ort ❑ Motel ❑yy Other q r --x040•--•'------- f Number of livingunits: -------- Number of be ___---_ Number of baths s¢e tom' -- -- Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ t Previous Application Made: (If yes,date................._.) No 9?'* New Construction: Yes R�4N o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f r______ from f_o-_undation_ -----.- Materia - -------------- Se tic nk: Distance from nearest well-5m- Distanc No. of com artments___ S �/ -__Liquid depth__._-_ ._.----._.._Capacity../AQd ---- , ze- f .� from foundation ®--._ Distance to nearest lot live----------------- Disposal eld: Distance from nearest weli.5?V-.-____Distance �_ _.:__ e__- +F Number of lines------ ----- -, Length of each line--gg.. -- Width of trench------ -------------------i•-- Type of filter. material- �C4-_Depth of filter material_../1__.s.-___Total length__.__________-___-._ 40-43_______ uEr rest lot line____ ------------ SeepagePit: ianeetf nearest well--_-..__;__-._______Distance from foundation--------------------Distance to nea El Number p' Lining material-----------------------Size: Diameter--------------- -------Depth-__ ---- _ ._ -------- -- Cesspool: Distance from nearest wek!___:______-____-Distance from foundation-r-;_____-.__._,_Liningf material__ - _---__________ _____________. ❑ Size: Diameter-------------------------- -------Depth---------------------------------- '----------.-Liquid Capacity- ------- ---sT- --------gals. 6 Privy: Distance from nearest well-------------------------------------- --- -----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--:--------------------------- ---------------------------------------- ---------------------------------------------------------------- p Remodeling and/or repairing (describe): ---�'-!a�' - _._ ! ` i r - -------------------------------------- ---------------------- --- -- ----------------------------------------------------------------------------I -----•-------- --------•------- -----•---------_------.------- ------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------- ------------- ------ --- --------- ------------ ----- ------ '5 I hereby certify that I have prepared this application and that the work will be-done'in accordance with San Joaquin County 7�1, ordinances, Sta a laws, and rules d regulations of the:San Joaquin Local Health District. G .> 1`v. Owner an or Contractor) (Signed ------ -- ----- (Signed) ---------------------- (Title) -- Y= (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------- DATE 4�- !s ��-- ------------------------- -1`---�----------- REVIEWEDBY-------------------------------------- - ------ DATE--- -------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------- - ---------------------- --------- DATE------------------------------------ --------------------- -- Alterations and/or recommendations-------------------7--------------- --------------------------------------------------------------- -------- --------------------------------- ----------------------------------- --------------------------------------------- ------------------------------- --- - ---------------•• r ANAL INSPECTION BY:-.-�- - -. Date---- ------------------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hazelton Ave. 300 West Oak Street * r* 124 Sycamore Street 205 West 91h street Jr Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.