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FOR OFFICE USE: `> G APPLICATION FOR SANITATION PERMIT Permit No. .. ..�_.__.. _.� < <°` _.. (Complete in Duplicate) t -____________________ This Permit Expires 1 Year From Date Issued Date Issued ................ Application is hereby made to the San Joaquin Local Health District fora permit to construct and inst II the work h ein describe This application is made in compliance with County Ordinance No. 549. yv- ----- ------ � ----------------------------------- JOB ADDRESS AND LOCATION---------6_7--_-N..._ Owner's Name ------ Phone�8_J.'_-315.3. _._ ,� -•-- .� �` --------------•-•---------•-----------------------•-------------------------------•------- Address �1p� -------------------------- r'- P Contractor's Name--•---------<` !•/,t _`--••----------------------------•---•--•---••--•----••--••------•--------.-. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A__-- Number of bedrooms Z5... Number of baths -1----- Lot size .....'7S1_-_'_----.x.... --.-`------------------- Water Supply: Public system P Community system ❑ Private ❑ Depth to Water Table _60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_-------_) No 0 New Construction: Yes ❑ No X FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank pr cesspool permitted if public iewer,lis available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation___-.-_--_-_--_-_.Material_--_--_--___-_.__--_--_-_--_-_--.-.._------:-_. ❑ £%1��"A'""",� No. of compartments--------------------------Size--------------•------•---------Liquid depth-------------------------.Capacity--------------- ------- Disposal Field: Distance from nearest well_-1L, -Distance from foundation.....t"Q. ......Distance to nearest lot line._:3 ........ Number of lines...........,/---------------------Length of each line---------3'S_.'_--_------Width of trench-_- : �A Type of filter material--- ---Depth of filter material--.- length................3j_-1.............. 00 Seepage Pit: Distance to nearest well-' Distance from foundation.....la_'___.Distance to nearest lot line_---c �.. ._,• J 15 CAA Number of pits......- ------------Lining material.#160_C" ._ Size: Diameter----_-zF, 3g_16epth--.___..-- 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-------------------------------------------------------- u -----------------•----------•------------•-----•---------- Remodeling and/or repairing (describe):--------- /` = -�-- t st--c�jr '�--� ------------_----• 9 -•----------------•.--_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------I------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------• ------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------•------------------------------------------...•---------------------------------------------------------------- --------- 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) /55CL ------ ---I---------------------------- -----------------------------------------(Owner and/or Contractor) Title------- ��" By: ----------------- �ce� ----- (rifle) (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..------ - �------ --- `z=' �--_-= DATE '7 / REVIEWEDBY_---------------------------------------------------- _------------ DATE------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------ --------- --------.�- DATE ----------- ----------- ---- Alterations and/or recommendations �J N/... u --------------------- - -./ - n 'E` J L..c !Z--- ----- --- �f --- `Z--- /'` 2 -�:QCs `� "E --- - - f -, r,- ----------------- --------------------------- --------- --------------------------------------------------------------•- ------ FINAL INSPECTION BY:.- --- --------- ------ - �._ .. Date-------------------- r - `----------- ----------------. -- rAN OAQUIN LOCAL HEALTH EALTHDISTRICT 1601 E.Haselton Ave. /300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CD.