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FOR OFFICE USE: -------------------------------------- ------------------ APPLICAY16N FOR SANITATION PERMIT Permit No. ..../... 3 --------------•--------------- -- ----------------------- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued �?©S� Z?© �C y Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and ' st the work herein described. This applications made in, ompliance� .ith ounty Ordinance No. 549. JOB ------------- ---------------------- Owner's AND L13CAmwner's Name s ---------------------------------------------•----------------------------------- Phone...........------------------------ Address............ -------•---------------Address......------ t dZ' _ Contractor's Name�� 1'.t .. /. ---"--•------------------------- - ------------------------------------------------- Phone................................... Installation will serve: Residenceq Apartment House E] Commercial [-] Trailer Court ❑ Motel ❑ Other E] Number of living units: ___)__dumber of bedrooms _______ Number of baths-____•___ Lot size _Ajk v4z� Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table 7.0_ ft. t Cha)racter of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam Co Clay ❑ Adobe❑ Hardpan Previous Application Made: [if yes,date------------------__) No New Construction: Yes Z] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS= ZD I (No septic tank or cesspool pe�miHed if pub=ic sewer is available within 200 feet.) s ' Dis Septic Tank: No+of com artmentst_well. --------SDistance 'izea3 e�frQ� �ndatiLn�d de th-_Material_ �rial------�--••----�•--=-----• 1 G( P q I? Capacity ---.--.--- Disposal Field: Distance from nearest ell__450-_-_'"._Distance from foundation._/e.____.....Distance to nearest lot line... Number of lines._t ----------------------- Length of each line----/-------------------Width of trench_nY_"___-____---..-...... Type of filter material�"_040:+y ----Depth of filter material-.--.L-------------- length---JRQ----------------------------- f _________________I Seepage Pit: Distance to nearest well j 4__'_-___--__._-_Distance from,foundation__r _.___.Distance to nearest lot line_ _________ I Number of pits------ -------------Lining material4j__!--- --------:__.Size: Diameter__.:-__--------------Depth---•�-_-- ------ Cesspool: Distance from nearest well--------t'�-.._Distance from foundation--------------------Lining material_____________________________________ `s Size: Diameter----- --------------------------------1 % Capacity q �De th------------------------------------------------Liquid ------••....................gals. r� ! Privy: Distance from nearest well:________--------------------------------- -_---Distance from nearest building---------------------------------- :..:- ❑ Distance to nearest of line----------------------------------------------- -----------------}--- = �j > i Remodeling and/or repairing (describe):---/L!__-- •- �a/ -}---._�.(�-•--- - ► -• V., -----•-------------••--•----------•---•-------------•---------- •--- --� I ' •--------------------•--------- -------------------------------------------- ----•----•-----•-----•---------------------------- i ; ' .a L --------------- ------------------------------------------------------------------------------------------------------------------------------.------------------------------ I hereby that I have pre pared this application and that the work will be done in accordance with San Joaquin County �'r ordinances, tate laws, and rules andiregulations of the San Joaquin Local Health District. � (Signed)�i� s.__. x' �1 Y---------- ----- -••--------------------------•.-•---------•- ---- - ._..:Contractor) i By:----------------------------------------------- ----rile_� - -- --(-- - - -- - � . .....-------- -� Owner and/or Cor�trac (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). / J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYG ------------- DATE..... � _4-_�t'----------- REVIEWEDBY------------------------------------- i -------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- =----------------•---•---•-------- DATE------------------------------------------- Alterationsand/or recommendations:_1---------------------------- •-----------------------••--------------•--•-----------------------------•--••-•--•----------•--------•----------------------- r --•-•--•-------"-•------------------•---•------------------ -------------------------------...-------------------•--------•-•-----------------------••---------------------------•--------------------------- s a ----- ------- x ------------------------------- •------------------- .....------------------------------------------------------------------------------------ I FINAL INSPECTION BY. -O- , . . ,e(� _____________________________ date_S` 1 '�� t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Mkinto ci,California Tracy,California 4 E9 9 REVISED 0-59 PM 5-61 ATt.A9