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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------ — :(Complete,.in_,Duplicate[ Date Issued ._-._ _____1_«?.f! / 'Y ----------------------------------------------------------- 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 ma� in compliance with.,Caoun ?d� ,ance No. 549. M� J7-(—=c JOB ADDRESS AND 'LO i j)�_- 11 --A... vv....A---QF--•-Al11-,�----------------------------------•-- Owner's Name--- ---•---W-------.67F_Fi&F_1.7I7 — ----- Phone-----••---•----•---- Address7._<- ar .i—..... L. . ---•-----------------------------•-- Contractor's NameA,,4 _fll TlrQ _ S TI_C...-----..a� _ _�1-1 �.:....... .....•---------------------- Phone................................... VV � 4 Installation will serve* Residence PJ Apartment House E] Commercibl E] Trailer Court C] Motel ❑ Other ❑ Number of living units:-i------- Number of bedrooms 3__ Number bf b'aj.hsK ._ ;Lot;size -----�-- �..................... Water Supply: Public system ❑ Community s tem ❑ Private ��epZ To`Water Table 5_ ft. ? Character of soil to a depth of 3 feet: $and ".Gravel Sand Loam Clay Loam Clay Adobe Hardoan P ❑ Y ❑ Y ❑ Y ❑ ❑ ❑ Previous Application Made: (If yes,date________________ _) No 921" New Construction: Yes Flo ❑ FHA/VA: Yes ❑ No •. (/ -A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wiflun 200-feet.l Septic Tank: Distance from nearest well-----------------Di'stan`ce from Voundation--------------------Material-------- ---______-.____________...__.__________- TfrVC^ No. of compartments---------- - -----------Size --------------l--------- ---Liquid depth------------------------1 Capacity....................... Disposal Field: Distance from nearest well___5-0...Distance from foundation______t-0 -Distance to nearest lol line............ Number of dines_ `_ "�- Length of eacR line-------�Z __--------Width of french......' 0.1y....._._�__.... Typ3Nof filter material._._ __/9_"___Total length......................�s------ ---•- Seepage Pit: Distance to nearest well----------------------Distance from foundation________________....Distance to nearest lot line................. ElNumb r of pits------ ------ --- --Lining material--------------y_____---Si e'`Diamete F-i------- -----D®pth--------------------- Cesspool: Distance from nearest well------------------Distance from foundation.P.-1411411U'6iing [ materila I ❑ Size: diameter------------- -----------------------.De th-------------�--------- --------------------------Li Liquid Capacity--------------------------_gals . Privy: 'Distance from nearest well-_____.________________________________ _______Distance from nearest building.,___.______________________________.__--- ❑ Distance to nearest lot line---------------------------'.---- - #--------•-----------•------------------------------------- ------------------------------------- # • Remodeling and/Prepai ing (describe)-----------------------------_-- � ---------------------.�__._...__ --•--------•--•---------••----•--------- •---•--•----------------------•------ ---------- --- ---------------- -- :--------------------------------------------------------------------------'----------------------------------------------------------- --------------------------------------- ------•-------•--------------- .......--------•-------•----------•----------•------.._..._-..------------------- -------.-...--..-------------------- ------------- ---------------------- 1 hereby rt' y that I have prepared this application and that the work wil!`be done ina'c o ad nice with San Joaquin County ordinances, law an' fes and regulations of the San Joaquin Local Health District. q (Signed)----- __ _ _ ___. __ --- ____________________(Owner and/or Contractor[ BY:----------------�-,--.----•------------------------------ --------------------------------------------------------------------------(Title}--=------------------------------------..._..---- -------------- (Plot plan, showing.stse,of110t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY-------"rTR'-�-`------------------------------------------------------------------- ------------------- 'REVIEWED BY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ -(BU(LDING,-PERM IT-ISSUED_:--------------------------------------------------------_--------------------------- -------- DATE .`_----- ----.- ---- _.�,..... �.......... _. ,�.,. ._ 'iAFtera ions and/or recommen tions----------- ------------------------- ------ 1"------- .." -.- ------------------------ -------------------------••---- -•-----•------------ ------------------------------------ ------------------------•------ -------------------- - ----•-•-••------- E ------ j -------------------- ---------- -• ...... - ---------------•-----•-•---•----------------------------•-•-------------------•------------------------ Date -------------------.-.- ---------------------- R 6L FINAL INSPECTIO date. �l-_rt r -' - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS :Cr