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F�_jiZ OFFICE SE; APPLICATION FOR SANITATION PERMIT y Permit No. ---- ---------------------- -' - -!'-- -------- (Complete in Duplicate)_ �S _. This Permit Expires 1,Year From Date Issued r - ` Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. IJOB ADDRESS AND ATION,.._ U1___-_ _._ -------------------------------------------------------------------------------- Owner's Name---- - 7 ----------------------------------------------------------------------- Phone------------------ ------------ - E , Address ------------------------ -- -- -- - - - - --- Contractor's Name------------------------- -------- Phone------------- -------------------- Installation will serve: 'Residence [5 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number,of bedrooms ��r_ Number of baths --/-- Lot size ------------------------------ ! Water Supply: Public system V?r"'Community system ❑ Private ❑ Depth to Water Table 40/'.�ft� Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®r-Hardpan ❑ l Previous Application Made: (If yes,date____________________) No New Construction: Yes ❑ No SHA/VA: Yes ❑ No R4, z! .TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ISesRtic Tank- Distance from nearest well-----------------Distance from foundation---------------------Material---______-________.___..____________..________- . No- of compartments---- ; ----------Size---------------------------- ---Liquid depth--------------------------Capacity--•------------------ IDisposal Fiel;1: Distance from nearest well____ _____Distance from foundation____ Distance to nearest lot line__ -----_____- Numbet ! -..-- -----Length of each line-_-�-- -- r of lines--____-- __-. Q_ __-- Width of trench-,e ---_----.--•------------------ Type of filter material_ /S4 Depth of filter mater�al___.1 ________Total length____.9------_..__-____________________ Seepage Pit: Distance to nearest well_____ ._____Distance fr i fou dation_____ Distance to nearest lot line---_____y__v:_ Number of pits__ -----------Lining material_ .Size: Diameter_,; ....... +� -De thaw _-.... N Cesspool: Distance from nearest well-----------------Distance from foundation-------------------lining material--------------------------- w ❑ Size: Diameter--------------------------------------Depth-----------•-----------•----------------------------Liquid Capacity------------------------:---gals. li 'Privy: Distance from.nearest well-------------------------------------------------Distance from nearest building______________________-____-.______._._. Distanceto nearest. lot line - --- -------------------------------------------------•------------- ---------------------- ---------------------------------- --_----------- 'Remodeling and/or repairing (describe):--------- 4 �� 'r `--------------------------- ------------ ------------------------- ------------------------------ - ---------- --------------- -----------• -------------------------- i-------- •--- -------------------- •----•------------------------------------------------------------------------------ q i l ------- ---------------------------- ----------------------•-•----:----•---------------------------------- = 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 nd.regulations of the San Joaquin Local Health District. -- :(Signed)---------------------- ------------ --- -- - (�or Contractor) By------------------- --------(Title)-------- 1AM-- ------------------------------- (Plot ---- ------------- --------- �(Plot plan, showing size of lot, location of system.in relati to wells, buildings, etc., can be placed on reverse side). r ` FOR DEPARTMENT USE ONLY C APPLICATION ACCEPTED BY___.___ _...._ DATE----------- ------------------------------ - --------------- - - REVIEWEDBY----------- ---------------------------------------------- ---------'-= --- ----------------------------------------------- DATE------------- BUILDING PERMIT ISSUED _. - DATE --------------------- W _. �- s , �---------- Alterations and/or recommenda�ons: rr c �`_--` �r_'=�--- r ��t---------- ` `�`L- �� - - ---------------- ---------------------------------------------------••--•-------------------------- ----- ---------------------------------------------------------- i i i - . --- - --- - ------------------------------ ----- - ------- -------------------- ------------------- ---------------------------- FINAL --------- FINAL INSPECTION BY: -------------------------- --------------------------------------------------- S N JOAQUIN LOCAL HEALTH.DISTRICT S 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California ES 9 Rr=v19EO 8-59 3M 3-'63 F.P.00.