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' T FOR'0FFICE USE: 7 { �--- " APPLICATION FOR SANITATION PERMIT �� Permit No. .-f--.-. -? } ------------------------------- ----------------------"---------- (Complete in Duplicate) R5 ate Issued .- ---` ___ ____ --_----- --- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appl' in compliance with County Ordinance No. 549. � � T !� JOB ADDRESS AND LOCATIO 1/ ID. �/ A Owner's Name----------- 1 AL1 `�� r -.."_. d-- Phone--------- -=-------------------•---- .�. _ Q 4' -- ----- ------------_ ------- Address-------- P-Q'-----,�_Q-x--------�----_--r'�--=_= --__,i 1 _ Contractors Name----------•---- --�� -- ---- --------"-------•---"-"-. Phone ------------ -------- ------ - Installation will serve: Residence. House ❑ Commercial ❑i Trailer Court ❑ Motel ❑ Other ❑ f n � � - K 1 a ca------ -I-------------- Number of living.units'..-I---- Number of bedrooms --"____ Number of,bat�s """--_.. Lot size --" -----_"---."__ -_---". a t Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table �%Z-ft. i 4 Character of soil to a depth of 3 feet: Sand e Gravel ❑ Sandy Loam,[:] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan C]-q"Wk Previous Application Made: (If yes,date--------_-.--------) No� New Construction: Yes [�No [-] FHA/VA: Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: -Y �{No=septic tank or-cesspool-pernhi#ed-if`public-sewee`is�ailable withiin-:200 fee+:) i W__Distance from foundation--.-./ --:-----.Material"_�0 ----- SepticT Tank: Distance from nearest well_-__--.' - No. of compartments-."._ ._- Size"_ - �d- -J --Liquid depth----�� .---"-"--Capacity--- - ----Distance to nearest lot lin ----------------- Disposal ----�----- Disposal Fie4d: Distance from nearest elL. r"YAC.--_.Distance from foundaflon- Number of lines----------- - Length of each line_- :" ----------Width of trench"_---., �?___--- I t r Total length---------- -'-------------------- Type of:filte,matenal.xQ :_,-_,Depthtof,filter.maferial_-_-1-" -.............- ! j Seepage Pit: Distance to nearest well------------------------Distance from foundation-------------------.Distance to nearest lot line-_----:---------- I ❑ Number l)f pits------- Lining material - - Size: Diameter------ ---------------Depth--=-`�--------------------------- Nning material-------------------------- a Cesspool Distance nsarest well_.__-- .-".-D.istance from foundation _-- L p ...� 0 -ma c . sv{�-ji mit .A t __ a ❑ 1 ,.� '" Li uid Ca acit -- 9 ls. Size:'Diameters ----------------------------�. -x Depth- -------------- -------------- ----------------- �q Capacity "Priv � Distance from nearest-well-_ z - `-*_-.__-_--_ __-- Distance from-nearest building"_ ❑ Distance to nearest lot line-___--- ------- ---- --------------------------- ---------- ----------------- -------- ------ -------- Distance 00 Remodeling and/or repairing (describe)-----------------•------_y------ --------•----__-----------------..- ; ---1----------- --` --- -------------{---------- _c ----------------------- -----------------------------------------------------=----------;------�----------------------"------- ---------------- --------- ----------------------r --- F ------- ---- - ---------------------------- --------------------------------_ ' 1 hereby certify Lha+ I l4ave prepared this application and that the work will be done to accordance with San Joaquin County ordinances, State laws, and mules and regulations of thei San Joaquin Local Health District. .. (Owner and/or Contract (Signed) -- ------- By:— -- _ -------------- ---- ----- --_� $ •- :+,•2 `' _------------------------- ,of' ------------- ----- (Plot plan, showing size of:lot„lobation"of::sys em in relatiol 'fio wells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENTUSE ONLY' APPLICATION ACCEPTED BY------------ DATE-""-_. ---_�_" ®.` REVIEWEDBY -----------------------------------------------= ht "--'- ------ ------------ ------"--------------------------=---------- BUILDINGPERMIT ISSUED--------------------------------------- ---------------------•-----=----------- -- DATE Alterations and/or.recommendations:------------------------- -------------------------------------------- ---------------------------•- F -----------------------"-----------------------------••_----------------------•-------------------------- ------------------------------------------------- ---------------- , •------------------------------------------------ ------------ ^:---------"--_-------_-_.----_--_.---." ----------------------•------------------------------ . -"-.a_------ ---- __ _ --------------- -------------------- "-"----------.-.....-.-------"-"-- "..-.-_--"-". ------ pp- --- - I FINAL INSPECTI . . . -----• ---------- -- Dae - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California s r:5 9 REVISED 8-59 3M 3-'63 F,P,C[3- ^>:c 3 -