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rvK urrj(–t u5t: ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._ _ � ------------- --------- -------- - -------------- (Complete in Duplicate) ------------------------------ --- This Permit Expires 1 Year From Date Issued Date Issued _� ,- S� /- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he workh re--tri~®cri ed. This=application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO AT N ��--s�i � / 14� Owner's Name _ 1� _-- -----•-------------- ---------------------- Phone ------•- Address...... '-_--- > ' - -------------------------------•-- I Contractor's Name-_-__._ - .j��7_�eV ,,111— -------------------------- ----------- ---------- ------------------------ Phone---------------------- Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms.. Number of baths __. Lot size _4?4ew- - . � Water Supply: Publics stem / --------------------------------- PPY= y ❑ Community system ❑ Private [ epth to Water Table .� -ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay [] Adobe❑ Hardpan ❑ -� Previous Application Made: (If yes-,date- ..,___ ---- No f r ��New Construction: Yes [YYlao ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPiCIFICATIONS: { I J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ii rr -Septicjank:. Disfan ce-fromrn ear-estrwell Ar99 Distance from=foundation ` r f�A-=--..Materialw�__;'R.Ii��t%!�- ------ __ �-,d ®� No. of com artments_ t04 C �'�Xl 'Liquid depth -_-. Ca acit p I �----- -----------Siz -------- - p y_lz. ------ Disposal Field: Distance from nearest well-/4q .. Distance from feunclation__e z2!--_-----Distance to nearest lot line ( -�"-• ®� Number of lines___..__________ _________----Length of each line_r �1�___ ��-_._.Width of french-At f--- T e of filter material. ---- Type � 1 � Depfih of filter material.._'-----_Total length--_o"" --------------------- Seepage Pit:Pit: Distance to nearest well__---.----------------Distance from foundation-------.------------Distance to nearest lot line--_--._-_---....- ❑ Number of pits...------------------Lining moferial-----------------------Size: Diameter-------------- --------Depth_-------------------------------- Cesspool- -------_ ZI Cesspool: Distance from nearest well-------------__-Distance from foundation-------_-----------.Lining material_._ ---__._____--..--_ "400 Size: Diameter---- - Depth __ --------------- iF e Privy: 1 --------------------------- --------------------- -.-. - i uidCa acitY -- ----------- --------gals. > from nearest well--------------- ______ _____________Disfance from nearest building ' ❑ Distance to nearest lot line---------------------------------------------- , --- ---------------------------------------------------------- E Remodeling and/or repairing (describe):-___-.-72 - t `�O%�� ---4_e�- ----------I--------------------------------------------------------- ----------------------------- --------------------- -- -------------------------------------- 4 --------- 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 Local Health District. 1 (Signed)---------- � r ---------------- ---- BY= ----------------- -(Title) r Contractor) i. ----- -- -- - - -------- plot- lan.-showin y - -------- ---------- ( p g-size-of,iot, feta+ion ofs-system-m relatio wells,-buildings, .efc.',f can,6e�pJacedaon-reverse side).�;r� . FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY_---------------- ---------------- r� --- - C1-Q , ��01 DATE --- - ------------- IEWED BY----- -- ----------- ----------=-- -------�----- - ------------ __ - -------- DATE;----- --- BUILDING PERMIT ISSUED------•----------=------ ----- - ------- •----•------ --------------------- -- --------------------------------------------------------------- DATE----- ---------------------- I Alterations and/or recommendations:.-`------- --------------------------------- ---------------------------------------- --------------------------------------------- -- ---------------- iij ----------------------------------------------------------------------------------------- --------------------------- ------------------------- FINAL INSP ON B .lfiv... ....6)_ Date.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.co.