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FOR OFFICE USE: --- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..l..-•/- -- ----------------- - - ----- (Complete in Duplicate) Date Issued -_-�/_�_ _�'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 made in compliance with County Ordinance No. 549. 2s iJ ._ f`FG•-0� JOB ADDRESS AND LOC$TIO i r✓dy---6o.,! ��' Pl�.� /�_c-J----------------------------i------------- Owner's'Name---- --------------- —1 ` '~---•--------------------------------------------------------------------- -... Phone----------------------------- � L Address �`'-� - ________________________________________---_------__- __ T Contractor's Name-_.--•----------- '¢� - ------------•-- - ------------------- '._ Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial }', Trailer Court [ Motel ❑�} Other ElNumber of living units: -------- Number of bedrooms .------- Number of baths -------- Lot size -------S7_ _-lT`------------------------------•- Water.Supply: Public system ❑ Community system ❑ Private k ,Depth to Water Table -------- ft. ' Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date___________________I .No New Construction: Yes No E] FHA/VA: Yes ❑ No [� TYPE:OF INSTALLATION AND SPECIFICATIONS: - (Na septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Se tp " Tank: Distance from -nearest weil___&_0____Di s n exfr�omxfo ldation--.'- -----------Mateliafl;__I'-- a .�J... ... _ No. of compartments_ �! -_-.---Size = Liqu � pth....__._L- 1 _."__Capacity-_ from � o-nce from f _ ��_-_---Distance to nearest lot line.__�1_-�- ,W Disposal Field: Nlumabeeof I nas��rest well--`----�------ �_Denath of each linnd�ation__ . P f Length e/5_-_ _ .' 'Vidth of trench__._,-�� 0 Type of filter material-ST1--z- �Depth of filter Material----�_ -------------Total length_._ ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-_,.--------------Distance to nearest lot line----------------- � El Number of pits --- -------------------Lining material-----------------------Size: Diameter-----------------------Dept h---_--.----.--------------------- , Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mater ial_____-_.__.---._------_--_.-_.----.-. — .Size: Diameter- •-----------------------------------Depth- -----------_- ------- ------- -------LiquidCapacity-_,- ------------------gals.- Privy: Distance from;nearest well----------------------_--._----_____---_-----..Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------i------------------------------ ---------------------------------------------------------------------------------------------- 4P. Remodeling and/or repairing {db ) escr; e :___a---= r`rr d _Y-Imo-------------------- �s<. � • !1 F ° ------ J -''c• �f�C'j,, :1`-.f_es—�lt� 22 omZ_--- ----- - - f ------ = ! ( I hereby certifyythat l have pre gyred this application and that the work willlkie done in accordance with San Joaquin County f ordinances, State aws, and ruled regulations of the San Joaquin Local Health District. (Signed)---- '��=- • {- / radar) J--~-�- ------ - --- --y_---�--:-- �;-.--:-. Owne�and or Cont ( ---- --------- -_--- Title--- " (Plot plan,showin� g--size location of system in relation to wells'buildings�etc., can-be placed in-Ireverse,side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- l-- ------------------------------- ---- ---------------------------------------- DATE------------------------------------------------=------- REVIEWED BY.----- } DATE----- y - ----------- , -- -------- --------------- ----- �f BUILDING PERMIT ISSUED-------•-- ----------------------- DATE — ---- . Alterationsand/or recommendations:--.------------ -------- - ----------------------------------------------------------- ---------------------------•------------------------------ t -------------------------------------------------- ------------------------ ---------------------------------•-------------------------------=------------------------------•----. -•- ------------------•----------------- ---------------------------------------------- -•------------------------------ ------------------- f Y-" --------•---------------- -------------------------------------- - ---------- --------- ------- --- -- -y., FINAL INSPECTION BY:-------- -------- ---------- Date--------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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