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FOR IJFFICE USE; ----------- ------- -------------------------- APPLICATION FOR SANITATION PERMITPermit No. __ _ -----"__---- - --_ __ __ --------" ------ # (Complete in Duplicate) Date Issued . � �- -- --------- --------------------- This Permit Expires 1 Year From Date Issue 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 AN LOC TION_ - ; ------------------- Phone_ 44J—.' ---•--- Owner's Name- �* -•---------- ------ Address__..-s''--••--- •-• lPhone off --Cep -=�A eq 7 Contractor's Name--------�=---------F.z -----------•---- t►s�E� ' In on will serve: Residence E] Apartment House [ICommercial ❑ Trailer Court Motel E] Other - - ------�-- -"'--�`-------- ---- Number of living units: -------- Number of bedrooms -------- Number of baths --�- Lot size ---- --�------ Water Supply: .Public;system ❑ Community system ❑ Private Depth to Water Table-g._ ft. pan Character of soil to a depth of 3 feet: Sand ❑!-Gravel ElSandy Loam Clay Loam [IClay [I Adobe❑ Hard No El Previous Applicafiom:Ivlade:�{If_yes,date------ -------) No [I New Construction: Yes No E] FHA/VA: Yes E] TYPE OF INSTALLATION_ANR-SP-ECIF.ICAT-IONS:,�,Q. - - - (No septic tank°or_cesspool permitted tfpublic sewer is-available within_200-fee+.) —�• - n - 1/ 4 _ +- Matarlal Septic Tank: Distance from nearestrwell_�.-- --_ Dis#enc from foundation- , Capacity./20e p rr Size_-tl��rl •Li uld de tl, �� -------- .7 + No. of`compar-tmenfs:--_ -_: ___-- q p• R4 r ! ,0 Distan to nearest loft line----------------- Disposal -_--- 5--. Disposal Field:f• Distance from nearest weli_o----_ Distance from foundation_ d 1 , # Number of lines.-- - - -- ---- ------ Length of each Isne_ - _ ----- o trench.."-_ . -- =--- / Xi 1 t Typeof'filter material !_ _ ` Depth of. filter material_-- _---. -Total length "----__.-:_ d �i = i ; 2 pi ' Seepage Pit' Distance-to nearest well---- -------------Distance from foundation--------------------Distance to nearest !ot ine"."_.-----_-_-"".� ❑ Number of pits---------- ----------Lining material---------------------------Size: Diameter-------- -------------..Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....------------- .Lining material-------------------------------------- vl Depth-----------------i---- - gals ❑ Size: Diameter-------------------------------------- - - - ---------- ---------Liqusd Capacity--------------------•- I Distance from_nearest well-------------------------------------------- Dist _.-. --_-__ ---._Distance from nearest building------------- ----_-----_._-----..-"- Privy: ------------------ i k ❑ Distance to"nearest lot.line-- ---------- -------- ----------- ----- ------------------------------- ------------- ------------ ------------- --------- -- E1 ---------•-----------------•-•---------------------------------- Remodeling end/or rep airing.(describe):-------------------- ----------- ----- ------- . -< y --------------------- t � •------------------------ ---------------------------- 1.t1 ----------••----•---- --------------------------•------------------------------------------------------------ ---- I hereby certify,that I have prepared this application and that the work will be done in accordance wifih San Joaquin Coun+y 1 ordinances a laws, and rules and regulations of the San Joaquin Local Health.District. � ♦ F f (Signed) ---- ----------------------------------------------- ----- (Owner I and/or Contract -------------------- ----------------------- (Plotplan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY P DATE. - C APPLICATION ACCEPTED BY-------- ___._ ----------------------- REVIEWED BY------------------------- ----------------------------------------- -------�-�----------------•=---••--------------------.. DATE---•----�---•------------------------------------------- --- ° - --- -----------------------------` DATE..------•---------------- ------------ --------------- BUILD-ING PERMIT ISSUED----•-•------------------------------------------------ --- ---- -- Alterations and/or recommendations:---------------------- ------------------•------------------------""- ----_. -------------------------------------------------------------------------------------------------------- ----------------------- ------------ ---------- f-1 ------ ---- ---------------__----- - --------------- Date-- V - -- --- - FINAL INSPEC I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatolion Ave. 3o0 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Man eca, Stockton,California California Tracy,California ES 9 REVISED s-S9 3M 3-'63 F.P.CD. _ f F