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FOR OFFICE USE: � � ` -/--Jl ?__ ----- Permit No. . .11-4 .05;`� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) --------------------------------------------------------- ---------------- Date Issued . ------------------------------------------ This Permit Expires 1 Year From Date Issued s_- `P as Applic _tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the��erei dees•Lcribled. This application is made in compliance with County Ordiname No 549. JOB ADDRESS AND LOCATIONQ R-/-- G � `�! j'�' Owner's Name , Phone-------- -------------•---•-------- ---- Address-- --------•----------------------------------•-------------------------------------------------- �? Name.------. -------------- ------------------ -------------•------•----------- •---- Phone---------------•--•--------------- Contractor's Installation will serve: Residence Y<Partment House ❑ Commercial ❑ Traily Court ❑ Motel ❑ ,�Osther ❑ Number of living units: __ ___ Number of bedrooms,,_ Number of baths 46W size 1��,� f� ' Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table I 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gratt!el ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made- (If yes,date--------------------) No [t)—New Construction: Yes Zle-N`o ❑ FHA/VA: Yes R1,..-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distant from foundation.-4 0--------Material__ ®/° �� .. ' No. of compartments__ _________________Siz Liquid depth_ __-.._...._______Capacity"'4Z4.4 --.- Q.Q-•-• Disposal Field: Distance from neares well.-..-----_-Distance from foundation./,�-/-.--.Distance to nearest lot line__�.___�__. Number of lines_______ __________ -------_ Length of each line____ __ / Width of trench._ -__._,______---------__-_-- �3 --- ------------ Type of filter material/y,,,o*Zec Depth of filter material__z4e---------Total length__"_t. 07________________________ / Seepage Pit: Distance to nearest well____"______Distance fr m fou dation__ ti'...._`=Dis# nc to nearest lot line__~_____.. Number of pits_-_-_02~--------Lining material__�0 Size: Diameter �-�----Depth-,.21.0-~�----•--------- 1l1 Cesspool: Distance from nearest well-----------------Distance from foundation---------------.-----Lining material____._____.________.________--__.__. ❑ Size: Diameter------ ------------------------------Depth-------------------- ------------------Liquid Capacity------------------------._..gals. Privy: Distance from nearest well______________________ _ ------Distance from nearest building_____._________-___________---_---------. ❑ Distance to nearest lot line------------------------- --------------------•-------------------------------------------- Remodeling and/or repairing (describe)------------------/ - ----------------------- ------------------------------------ ----------•----- -------•----------------------------•--------••----------...-------------------------------------------------------------------------------------------------- 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. 1 --------------_{O�r Contractor) (Signed) -------------- ---- ...... -'------------------------------------------------------------ (Title)-- )--0^4i '----------- -------------- (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U E ONLY ` DATE---` �lC APPLICATION ACCEPTED BY-- ` .: �it ' ---------•- ------------ REVIEWEDBY----------------------- ------------ -------------------------------------- DATE------------------------------------ BUILDING PERMIT ISSUED-------------------------------------- -•---------------------•-------------------------------------- DATE------------------------------- _------------------- --------- � Alterations and/or recommendations:------------------- - --•-------••----------------•----- -----------•-••--- --------------------------------...-------------------- -------------- -- - ---- ------ `l}1 -----•----------- --------------- ----- -------------•------------------------------------------------------------------•--------- -------------- -•-----•----------.. FINAL INSPECTION BY:.�-�---�-.1----.�•�C•_-t_�.f`•'C/1�� Date------'.-------- ---------- ---------------------------------------------- . , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodir California Manteca,California Tracy,California k E5-9 REVISED a-59 F.P.aal ZM 6-60