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FOR OFFICE USE: -------------------=------------------------------------- ------------------------------------- -----------------:------------------------------------- -----------------------------------:---------- -------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- ---------------------------------------- -- - Com plate in Duplicate) ---------- ---------- ---- ------------------- �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 h rein described, application is made in compliance with-County Ordin ance No. 549, JOB ADDRESS AND LFCATION,____'_A._. -- A9 -- --------------- r------ Owner's Name-' ----------------------------- ------------ -------- Phoneev3g:�7_719D 111Y ------------ - Address-.- Contractor's -7-091---Ct----_------------------------ Ph o n e).9 Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court El Motel 0 Other E] Number of living units: -1---- Number of bedroom's _Q;,.Nurnber of baths I--- Lot size ---Rjj:-A(jqff Water Supply: Public�system E] Community system [] Private$ Depth to Wafer Table __'60 ft. Character of soil to a depth of 3 feet:j Sand E] Gravel E] Sandy Loam El Clay Loam El Clay 0 Adobe V' Hardpan ❑ Previous Application Made: (if yes,date---- ---- ----------) Nok New Construction: Yes Ej - NoX FHANA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic fank'or cesspool permitted if public-sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_5117'Distance from.fou n claf ion- Material---------------___-.--------------_-----.__-_- No. of compartments--__-_..__-' ----------Size-AM50, _ _6X �-/ _� Liquid dep.fh-------------------------- Disposal-Field: Distance from neare well.___, _').._ a-5- _ Disfance from foundation- 1-----Distance to nearest lot lin.-3 Number of lines---:---- ---------------------------Length of each line-----[00-4 _rWidth of trench----)- Type'of filter mat t _.._______--f----- erial__4Kq!5;��-----Depth of filter maferial-_j1�--- Total length-----------------APO------ Seepage ength-----------------APO------Seepage Pit: Distance to nearest weII._/Z>()k.TDisfance from foundation-j.1-5-------- D;;fanc p --------- ,f to nearest lot Number of its-_------- ---------Lining material__ Diameter------------, -- --------Depth-1_01j?-_/;------------- Cessl600l: Distance from nearest well------------------Distance from foundation..._---__.---:-- Lining material------------------------------------- El Size: Diameter--------------------------- -------`Depth----------------------------------------------------Liquid Capacity -------- ----------------gals. r Privy- Distance from nearest well--------------------------------------------------Distance from nearest building ---------------------- ------------------ Distance to nearest lot(desline----------------- D R-amod 4/or repairing describe -------I QAm@!ggL -----------------------------------------------------------------------------------r � F ------------------------------• -------------------------------------------------------------------------------------- ---------- ----------- -------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------------- I . - -------------------------- ----------------w-------------------------------------------------------------------------------------------------:------------------------------------------------------------------ -------------- ------------- 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)___0-w-K.-A y 09 a---------------------------- ---------------------fQ4meP-&nd/or Contractor) M_ V-6_2YT I------------7------- ----------------------------------------------------------------------------------- -4- - ..- -. ---------------------- - -- ------- -------- (Plot plan, showing size of lot, loca+i'go-T iysfem in relation to s,will e buildings, etc., can be placed on verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-..-__-1-:_t. ------------------------- -- -------------—------------------------ DATE---------3- REVIEWED BY.��--------------------- W -------------- ---------------------- ------------------------------- ------------------------------------------------r DATE --------------------- BUILDING PERMIT ISSUED--------- ---------------------------- ---------------------:----7�-7:---------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:-.----- --------------------------" ---=--- =----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------------- --------- ---------------------------------------------------------------I--------------------------_- --------------------------------------------------- ------------------------------------ - - --- --------------------- --- ----- ----------- ---------- ------------ --------}--------------------•-•-• --------------I ------------------------- -------------------------- -------------------- ------------- ...... -- -- -- --- ------ - ........ ... .. ... ----- - -------------------- ----------------------------------------------------- --------- ------- --------------------- FINAL INSPECTII 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 FS 9 RrVMED B-59 3M 3-63 F.P.C O.