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r` FOR OFFICE USE: ,e � -- ----------------------- -------f-- -------- _ uz; _d APPLICATION FOR SANITATION PERMIT Permit No. ------- ----- (Complete in Duplicate) fe, -------------_.._... ---------------.--------------..__ This Permit Expires 1 Year From Date Issued 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. W JOB ADDRESS AND LOCATI N---- ------ `"------ �•-------------------------------------------------------------------------- `J --- Phone-------------------------------- Owner s Name----------- � - - ------------ ------------ Address ---------- - i `+ Address------------- -----• -�-•-• ----• -- ---- - --------------------------------------•-------------------=r-•-------- ------------------------------------------------------------- Phone ----------••-----....-----------•--.. Contractor's Name------/ -- ------------------------- Phare.... Installation will serve: Residence 23---Apartment House ❑ Commercial./0 Tr6 er Court ❑ Motel ❑ Other ❑ t Number of living units: --- -- Number of bedrooms _9?_ Number of baths ___ Lot size ------------------------- Water Supply: Public system ❑ Community system ❑ Private/Depth to ater'Table 61 It. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam F1 Clay Loam ❑ Clay ❑ Adobe ---Hardpan C] Previous Application Made: (If yes,date_ ________________1 No [v New Construction: Yes U2-1to ❑ FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:. i (No septic tank or cesspool permitted if public se6ver is available within 200:feet.) I P ___ oundation_-:_/-�-.----.Mater�L--:!fir_!/ .----.--.-• �`'� Sizes /✓ `.... Septic Distance compartme is}_W`' --Distance .from f Liquid depth____ Capacity_._ p�.___ LST / ��,�C � Disposal Field: Distance from nearest welff� ___...._Distance from foundation___ /_ Distance to nearest lot line_____-.__._. f ----- S f f f Number of lines____________�_ � __._ ength of each Pirie__- Width of french__._______.____.___-_-_--_ �1 ` T e of filter material .._ /-- e th of filter rmaterial_____l._ ----------- otal len th______ .. Y P f P �£4 . 9 r Seepage Pit: Distance to nearest well_ �_._.___Distance fro fou ation____� _____. Distance to nearest lot !��____._ Number of pits-1�1-//-___._______Lining material____ ��Size: Diameter_, __._-._- Depth__��.,��_./ _6--� CCesspool: Distance from nearest well-----------------Distance-prom foundation--------------------Lining material------------------------------------- Q F1i' Size: Diam/eter---- ---------------------------------Dept h�*-__"----------------------------------- --------Liquid Capacity----------------------------gals Privy: ) Dista Fceffrom nearest well.-.___________________________P.___._.____._.._Distance from nearest building------------------------------------------ 40 Aj Distance to nearest to+_lireri___.__---------_ l Remodeling and/or repairing (describe}________________ __ /�/S� �--- --- -------------------------------------------------------- A ---------------------------------------------------------------------------------------------------------------------------------- --------------- --------------------------------------------------------------------- __________ ___________ ______ _____________________ -__________-:_____:-____________----_-----:________________::__________:__ _____-----_________________ _:_____ __::::_::::: 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 reg ations of the San Joaquin Local Health District. I. Signed)----------------------------------- -_--�----�_� -.(�or Contractor) _ I(Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY F ------------------ DATE---9.-'-( .------------- ---- .APPLICATION ACCEPTED BY_..__. __,_ 5R_=------------------------------ REVIEWEDBY--------------------------------------------------- ---------------------------------------------- ------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------- ---- --- ------ DATE-------------------------- -------------- ------------------ Alfe rafi6ns and/or recommendations:__--_ .__._.(4.5.2�(a..A------------ ----_--__ ----- ~ ------2,-- ---•-------------------- . :--------------------------------------- ----- --- --------------- ---------------------------------------- ---------• ---------------------••--------------------------•------------------------------•--------------------------------------------- ---------------- --------- FINAL INSPECTION BY:... --'-.-6�:5------------------------- ------- Date ------------- --- ---- --------------------------- SAN-JOAQUIN LOCAL HEALTH DISTRICT t ) 1601 E.Hazelton Ave. 360 We'si Oak Street 3}.�� ► �",1'24 S c�mor�St"r�t 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California F.P.r_0.