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FOR OFFICE US : /A ------ ------- ,.,, APPLICATION FOR SANITATION PERMIT Permit No. __ SC�r.7..3 ------- ---------------- (Complete in Duplicate) 5 ____________________________ ------------------ 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. JOB ADDRESS AND LOCATION--- -��--- --`S7------------/1�CX-i--•------�. �//2t-12P tJ.S�-----O�f.-- -L c�r9 T��_... Owner's Name..-_4--YaCM ----•- ...... Address-------321.1.........&-3_TF12_po—------mow.-----•---•••----------•---•-•-•------•--------------------•-•-----•--.......-•------•-----------------•---------------- + Contractor'sName :._/�1 -� h`•-•-�es:TD✓S---f ---------------- --------•------..__..__ Phone... .�.�.9�t�•7 Installation will serve: Residence ❑ .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel-[3 Other ®" '4 } Number of living units: -------- Number of bedrooms .'....... Number of baths ___�__ Lot size .....6Q...._..X......`?1� 1r..................- Lr .t _ _ . -% Water Supply: Public system [Community system ❑ Private Ef%Depth To Water Table A;0. 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 New Construction: Yes �No ❑ FHA/VA: Yes ❑ No [>� TYPE OF INSTALLATIONµAND SPECIFICATIONS: ' J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) !1% 3 Septic Tank: Distance from nearest well__IV0A1>w Distance from foundation.___! _._.Material ____..6r0 �'�.� ___..__. ., i 0-jcf No. of compartments----------- ----------Size �._� = _ __.___Liquid depth-------'r�__._--_______Capacity. _-.Se Disposal Field: Distance„from nearest well-NON.1._Distance from foundation---j1.7_i--------Distance to nearest lot line---- � 1 Numbed of lines----------.--------- ----------Length of each line------- '-----------.Width of trench----•--------2 ---------- Type of filter material.. k0a,/------Depth of filter material______-.l8_"...Total length...................le�---___--__ _ �p • Seepage Pit: Distance to nearest well_ lO1YC-__Distance from-foundation--_ZO_�-..___.Distance to nearest lot line__.,_.r___.. ® 6LI Number of pits-----------_._-_-___Lining maferial___,F—CCA�' .Size: Diameter----._-3-.5'- Depth...........2�S--_'____.-----. _ I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material•.._____________._-________________ f ❑ Size: Diameter--------------------------------------Depth----------------------------------- ----------------Liquid Capacity------•--------------------gals. Privy: Distance from nearest well________________y__--_-_____.-_.-------------------Distance from nearest building------------I-______-_•------._._...__.._- ❑ Distance to nearest lot line---------- ---------------------------------------r-------------------- -----•-----------------------•---------- •----------------------- I Remodeling and/or repairing Idescribe):------ •--•--------------------------•------------------••------.............................. t ------•----------••-------- --- ------------------•---•-----------------------------------------------------------------------------------------•--------------•--- —-----------•---------------------------- 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. (Signed)- D------------ --C-----•• ------- --------------------------------(Owner and/or Contractor) ". BY:------------- -----------------------------------------------------Title-----------• t ------ (Plot plan, showing size of lot, location dT system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY /Z ` ----------------------------------- DATE // -- ------- - ------ REVIEWEDBY-----------{------------------------------------ -------------• -------•-=- •---_-------------. DATE.--•----• --•-----------•--• I....••----•----•......------•. BUILDING PERMIT ISSUED : - -------�- ----�-----. - -- : D - ------- ----------------------------- ------------- Alterations ------- ----------- AFterations and/or recommendatlons:- ---------------------------•-----•-•-------------------------•------------------------ -------------------------------- • ------------------------------------------------------------- I -----------------•-------•--------------------••-------•--� --- --•-----•---------- l -------------------------- .......... --------•-------•--•-•-•--- --------------- ------ -------------------------..-..._.-_........._.-_......._...------------------------- ----•-.................... •------ --- ---------------- FINAL INSPECTI ., Date--- ------------------------ SAN J AQUIN CAL HEALTH DISTR 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-52 ATLAS