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--•--•-----._ ...FOR OFFICE USE:""--- ------- � ,,..r�`� - - -- ---- -- - - 9 ------------------------------- -- -------------------- APPLICATION SANITATION PERMIT Permit No. ._1711....... ` -------- - --------------- (Complete in Duplicate). S'l _ _ .... Date Issued ----- --�J-(�_S -- ---- ----- ------ This Permit Ex ices 1 Year From Date Issued 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the orrk herb, cla-Zed. This application is made in compliance with Co my Ordinance No. 549. JOS ADDRESS AND LOCATION---CdA ----------------------- --------------------------- ------------------------ --- - -- -- - ----- - ---------- -- - Owner's Name---- Phone ------------------------ Addresses 1------ == - ------------------------------------------••--•- Contractor s Name r --�partment ----••--------------------------•-------'---------------•----------------- y----------- Phone-------------------------•--------- Installation will serve: Residennggce House ❑ Commercial ❑ ,�Trailer Court [� Motel ❑11 Other ❑ Number of living units:a_4Number of bedrooms -------- Number-of baths -------- Lot size --.-`.-----______�T__a----------------------___._--- Water Supply: Public system ❑ Community system ❑ Private% Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe Pff Hardpan ❑ Previous Application Made: (If yes,date.___...---_..._.:_) No /""New Construction: Yes —No ❑ FHA/VA: Yes ❑ No ®'''� __TYPE OF INST.ALLATION_AND SPECIFICATIONS: (No septic tank or cesspool permitted if ubhc sewer i available within^200 feet.) � � , Septic lank: Distance from nearest well , 0_.__Distance from foundation__.'------.___- " Materia4.__ _______ ______________ No. of compartments---2--------------- __Size0-1 Liquid depth____ Capacity___ . -_ ��([ � ��(( r------ --- isposal Field: Distance from nearest wellyzr.___ K an'c from foi<ation--____ter- .__.._.Distance to nearest lot line- ----- Number of lines-__-_13-1--- _________________Length of each line---1_.�i"_G"----------- Width of trench-" , __. ._ ----------- ---------- Type of filter material___. _j_ Depth of filter rriaterial_...l. Total length____ .&- _L _f,24> ----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation----I�cr____---.Distance to nearest lot line----_----_,___... pts ❑ Number of pits----------------------Lining material-----------------------Size: Diameter -----Depth------"----------_--------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------_--------Lining material--------------------------------------- El .-._._."----_-.._..----.__.-- .--_-❑ Size: Diameter------------------"-------------------Ds th-- - -- p ---- - - ------Liquid Capacity----- ----------- ----gals Pnvy: Distance from nearest well-_ -_._.__-----' _---_---_____ ________Distance from nearest building __..--____._----____________.___..._. : ❑ Distance to nearest lot line-- --- -------- - --- -------- -- -------------- - Remodeling and/or repairing (describe}---- -------------------------------------------- -----------------------------------------•--------------•--•-------------------------= ----------------•----------------------------------------------- -----------•-------------------------------- ------------------------ ---•------------------------------------ ------•----------------------f---------- 7 ------------------------------------ --------•-------•----•-----------•--------------------------------------------------------------------------------------------------- ------------------------------------------------ I heeA-},-certify that I have prepared this applica 'on and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and regulatioof t an Joaquin Lsscal Health District. {signed) r ---------- - =* � .1 -(Owner and/or Contractor)Y r n----- -----{Tttle � (Plot plan, show n size of-lot, location of system-in relation to.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -------------- ----------- ----------------- ---------------------------------- DATE------------------ - •----------------------- Rl VIEWED BY - --- ---------------------------- -----•---------- ATE- •; '_--. �. BUILDING PERMIT ISSUED - ----------------------------------------- -------------------- ----------- RATE - Alterations and/or re mmendations:._.-,� a �__cy �w __._ aa_-_--( _ JGf` .- ----------_____________________________________________Y..._______._____---------------------___._.;_ _�`_.-_._________._______________._.___._ .___________._.________._-- ----------------------------------------- --------------------- ------____ _--------------------------------------------------------___----------------------------------------------------------_-------------------------------------------- ----- -------------- -------------------------------- FINAL INSPECTION BY--- Date ------- ----- -------------- --- f ----= . -"-- f _. r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CD. f t�