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- -----------FOR OFFVCE USE APPLICATION FOR SANITATION PERMIT------------- Permit No. ..�.� 2).(....... -------------------------`--------- ------------------- -------------------------------- (Complete in Duplicate) Date Issued �-_�.�......._.. ------------------{------------ 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. r®�� -9 Jos ADDRESS AND�LOCATION....... .. 1 •1� rA10, �'yS' -�` /�' __r!_f�'R _�L/'S�------ -- ---- �y Owner's Name-----=-•-- '/ �� /.. ------- Z-- �" G�------ -- --- ------•--- Phone�_C�_•`C � 71?-- S .�4�-�-----...4�zz-----------------t...Address------------------------•---• ? -------------- ! II Phone..4- Contractor's Name_- �1��-- --------------••------------------------------------------------ c•_..._ Installation will serve: Residence ❑ Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---..___ Number of bedrooms -------- Number of baths -------- Lot size - .. � �" 5---•--•-----------------••----•- Water Supply: Public system ❑ Community system ❑ Private [a Depth to Water Table /D.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C1 Septic Tank: Distance from nearest well-/��_-_--_Distance from foundation__.I-�_____.___.�aterial_�p. 'T ________l.tS._.__. No. of compartments-_2--------------------Size' � `--b-------Liquid depth-__ -I?_.`0--------------Capacity./G��--_----. Disposal Field: Distance from nearest well--/Cc.--- ----Distance from foundation_-.-C-(______.Distance to nearest lot line.--�7__---_____- Number of lines---- --------------------Length of each line____7,5---`_-_. _______.Width of trench__�`,.____________________� Type of filter material�_ :___ 4�1l --Depth of filter material------/1�_ ___.___Total length---�GQ____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation___________....___.Distance to nearest lot line_-____..__._---_ ❑ r Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth-------------------------------- Cesspool': Distance from nearest well-----------------Distance from foundation--------------------Lining material-_._________--_.---.____.______-_____. ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity------------------------•---gals. _.•� Privy:-= t '. ,- Distance from nearest welt------------------------—- ------------------Distanc,; from nearest building-----------------------_---------------- ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------•---------------•------------------ Remodeling and/or repairing (describe):------- -- `�( I� � 5.7 __h f pop-0-us_-------, ----- ----- - -------------•------- -----------------•-•-----•----------------- --------------------------- ---------- ,w. ------------------------------I----------------------------------------------------------------------- ----------------------•-•----------------------------------------- ----------------------- I herety certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsi-and,rules and regulations of the San Joaquin Local Health District. d f� -------------- (I- - --- --- :--------•---- ---- -----(Owner and/or Contractor) ($i%ne )------------- --------- gY: r ' ` -- �-------------------------- (Tale) 5..:_-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------�� (y--------------------•------------------- -------- DATE----------------------------------------------------------- REVIEWEDBY------------------------------------- --- ----------I------------------------ --------•------------------------ DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------=~------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------ ---- --- - ------------------------------------ ---------------------------------------------------------------------------- ---------- ------------------------------------------------ -/ / /�f � !_ �°i r /.-1�. .-r P �--� az--- ---------- •-- ---•-------- -= . . r ... . rte_ , .°�Lf"fjr/f`---- �`�y-=---•-�=`-`-�----_-�`----s------------'-`1� ----t�.�c�-J'�_---,�1`-t°_�"�-_... �s�--1�:t?..-----.G=..__c,__=��c.�_----vt_�. - 47 -`'� � � `' •�`' f Vie' c � '----=-"�'`=;�-----�'f _ �:k �--• ----------------------------------------------------------------- =�----------- ---------------- F1NAL INSPECTION BY: Date-- ------ �_�--f-� (---- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Well 9th Street q Stockton,California Lodi,Catifornia Manteca,California Tracy,California EB-q FEVIBEtl e-Sg F•P•C tl.$M 6.6tl