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/ FOR/OFFICE USE: -------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... ... — --------------------------------------------------------- (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 Ordinance No. 549, JOB ADDRESS AND LOCA ION__-. S/BO .. � �.1417r .�je------------------------------------------------------------------------------ ---------------------------------------- ------------ Phone--------------------- Owner's Name Address. ......... -------- Contractor's ------Contractor's Name--------- -�- -Aoo---•--�------/----�----.-a---.-------------------------------• ------------------ ---------------------------------------•-------•---------.-_-. Phone---•-----••-----•---••--•--•------- Installation will serve: Residence Zjo'oApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ._ �_-. Number of bedrooms �__ Number of baths Ar__ Lot size,C=��-,�+(__1��.____________________.____ Water Supply: Public system ❑ Community system j2o'lrivate ❑ Depth to Water Table AW( Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®/Rardpan ❑ Previous Application Made: (If yes,date--------------------) No [L?'New Construction: Yes [p-No ❑ 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 we I___' '____Distance•from foundation----Zr�-___._..Material--(�r_ f'""__ ___________-_-___- �� No. of comparfiments_ ---- --------------SizeJX�� laiquid depth-----'___.---------Capacity_/_2.° .._.. Disposal Field: Distance from nearest weil.__^.---- .-.-Distance from foundation.... ---.Distance to nearest lot line__10� ______ W.i ! Number of lines_-__ ______ ____________.-. Length of each line__-__se ------------------Width of trench__ r__________.___-.-___________ Type of filter material;001 Depth of filter ___Total length-_1_0t o?__`____________________ Seepage Pit: Distance to nearest well_____�"`�_____Distance from foundation___ �` .��__�.___.Dist nce to nearest lot line___S,�_________ , Number of pits----A� -------------Lining material_,-r©.ei�-Size: Diameter-a';F _ Depth'114?11�-�!---------------- Cesspool: Disfa'rice'fromnearest well__"'-_____.__-__Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter. ---------- - ----------- --Deyth----------------------------- ------------- --------Liquid Capacity- -'----------gal Priv Distance from nearest well �. >. -:_____--___. ______Distance from.nearest building �•� Y { r R - - ----------------------- -------------------------------------------------------------------- Remodeling ---------------- ------------------------ Distance to nearest lot line----------------________:_.-__._._______________ Remodeling and/or repairing (describe}: P -----------------•--•------- ------------------ ---------------------------------------- -- -- -- r r - 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 Local Health District. . 1 (Signed)------ ;ore___ --------------- - --------- Contractor] ; G , J 1 s Title I ----------- By:----------------- ( ) fes/ " (Plat plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). �FOR DEP TMENT USE ONLY APPLICATION ACCEPTED B C -- - --- --- -- ------------------------------------------ DATE--- ------ ._ -REVIEWED BY----------------------------------------- --- ---- ---- --- --------=------ ----------------------------------------------- DATE----- ----- -------------------------------------------- BUILDING PERMIT ISSUED---------•-------------------------------------------------- ATE ----- ------------------ ---------- Alterations and/or recommendations:__ i _ - _�� i---------------------------------- A t Y � �-�----------------------------------------- SA -- FINAL INSPECTION BY:. ` Date ---...----- --. 6 JOAQU LOCAL HEALTH DISTRI 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi, California Mantecar California' Tracy, California ES 9 REVISED S-59 3M 3•-63 F.P.DD. [�