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FOR OFFICE USE: I-7,/ 1 -------------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. __-.--r•• •- - --------- {Complete in Duplicate)p } Date Issued --- _-G-.--l�y k " "-------------- - - -- -- This Permit Ex fires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein escri e . This application is made in compliance'with County Ordinance No. 549. I - rte-- ,�--7_11. .n JOB ADDRESS AND 'LOCATIO -------------- ` --- ------•---------------- Phone = -- Owner s Name.. -- -- - - _ -----•-•-•--•-•------•---•-------•-------- Address----•-------------4 �,- �_ ------ Contr.actor':s Name. --------------------- Installation -----;------•------ Installation will serve: Residence Q Apartment "House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - --------------------- Number of living units: ---I---- Number of bedrooms 4-___ Number of baths ----I--- o size --------------------------•- Water Supply:. Public system ❑ Community.system ❑ Private Depth to Water Table . -S ft. it: Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan New Construction Yes [� No E] FHA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,date.__--".--`,------- 1 No . . "_ TYPE"OF .INSTALLATION -AND SPECIFICATIONS: " {Ne septic tank or cesspool permitted if public sewer-is available within 200 feet.) s __ S •c Tank: Distance from nearest well'..- --Distance from foundatin Liquid depth Material--------------------------------------Capacity...... .....:..."..__._ >� ❑ No. of compartments ``=---- ----Size--------•------- - .. ..�- 4 D osal Field: Distance from nearest well' _...-.--Distance from foundation....................Distance to nearest lot line_-..-....._..... p ----- -------- -_Length of each line--------------------------=---Width of trench.------------.--------------------- Number of lines-"_________-- g -----Total length--------_------------------- Type -- 1 T e of filter material._..".-_;................D_epth•of fil+er.material".-_....""._- yp Distance from oundation..:��.�•---- .Distance to nearest�th-ne-----------•---•- Seepage Pit: Distance .to nearest well_-. "'�1'd------k' . ,��// pD Number of pits.;.--/------------..U'i'g :material-- ---Size: Diameter----'7-k.-. Depth-------------------------- ing Cesspool: Distance from nearest we}I__"--___-_....._Distance from foundation__"__.--- Linuid Capacity gals. Size: Diameter--=---- --------- --I-----------------Depth-----------------------=---------------- ------- a P y--- ------------- , . ❑ t r q -1 .. _ Distance from nearest building---------------------------- ----- -- Distance from Privy: �� Distance to earestelot I nle-- "-- .--- -- ❑ ----.------ I " ------ h Remodeling and/or repairing (describe)----------------------------------------------=•---•--- _= ,° --------_ -------- ------ G i , --------------------------------- fi ----------- ---------------------------------------------------------------------------------------------------- < iii - - I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify that ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. , xe Owner and/or Contractor) --- -- . - --.. (Ti e). BY:--•----------------•-- '-------- ' buildings, etc.; can be place on reverse side). � (Plot plan, showing,size of lot, location of system in relation to-wells, FOR DEPARTMENT USE ONLY .. -` --------- DATE--- _' _�.�- ---------------- -----=----------- APPLICATION. ACCEPTED BY_.. - - ------------- ------ DATE--------------------------------------------- ------ iREVIEWED BY DATE---------------------------------------- ------- ---------- BUILDING --------- BUILDING PERMIT ISSUED--------- ! ---------------------------------- ------------------------------------ Alterations and/or recommendations._-,------------- ------------ I -"-- ------ --- - ---- --- --- (- -y. r ----- ------------------------ --------- ------------------------------ ---- - - -- - --- -- . --- -_- •- T � P. - L i ----- --- ------------ ----------------------------------------- ------------- Date--- - ------- --- ---- - --------------------------- - FINAL INSPECTION BY: /-..- SAN JOAQUIN LOCAL HEALTH DISTRICT tool E.4tazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED B-59 3M 3-'63 K-RcD.