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FOR OFFICE USE: 1- APPLICATION FOR SANITATION PERMIT Permit No. --___-_.----.-- Date Issued.1 c7 .... ----------------------- ------ (Complete in Duplicate) f1> f _...-.---------------------------------------------------- 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 ' stall the work herein desgibed. This application is made in compliancey4th County Ord' rice No. JOB ADDRESS AIJ9 LOCATION.._ Owner's Name--- ---`-L......• --�--��-----•--------------------- ---------- P ne. A ----•------•--•--•�----•.... Address `^ ------ --- '"`°` =�' r .-- ►ra y _ i Contractor's Name...'�!.r�-R-r_ ..._ .'�. 1�_ .__�_t�¢.- ._:�'.-.... j-------•---------•................ -- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: _ ___ Number of bedroom ;/`-- __- Number of baths --_ Lot size ----- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam k Clay Loam�KNo'E] ay ❑ Adobe❑ Hardpan C]PP Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if �Pblic sewer is available within 200 feet.) t - Se tic Tank: Distance from nearest wel _p_�_____Distance from found a 1 Material_Q ' ___...___..____. p No. of compartments______________r t....._Sizel " � _�_ Liquid depth__&CZ."._` Capacity _ Ca acct -A& Disposal Field: Distance from ne$$r�,est well--6.C`%_....Distance from found ,/..•_0�_ ation. _____,.Distance to nearest lot line.......... . ... Number of lines.f�-_-- -__-- _ Length of each line_APA______:�?4:-----.Width of trench.c-�_r�------------- Type -d/' --_-___Type of filter material_ _ .. length--------------------.1F.- Seepage Pit: Distance,to rhearest well----------------------Distance from foundation....................Distance to nearest lot line____--_.- -____. / ❑ Number of pits----------------------Lining material-----------------------Size: Diameter ---------------Depth _.-----.•___--____ e Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lin ing rnaferial-__ ..-______________----- c ❑ Size: Diameter-------------------------------------Depth----------------•--•---------- ---------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------.__--_-_-_-_-_-:,__-.-_.--__---. Distanceto nearest lot line---------------------------------------------------------------------------------•---------------•------------•--•-------------------------- Remodeling and/or repairing (describe):_____-( ----------_ _ _ ._ - FM I --------•---------------------- -----------------------•-------------------------------------•----------------------•-•----------------------------------------•---�(-•fR_ _.0 ....._---•-------•-------------•------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- 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 Joa uin Local Health District. (Signed) ; -------------------------------------- 'v1d1Aw Contractor) By:.......... ----------------------------------------------------------------------- ------------ - -------------(Title)------------------ ------------- --------------- (Plot plan, showing size of lot, location of system in relation to w IIs, buildings, et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY � G APPLICATION ACCEPTED BY-----T- -I- -----------------------------------------------------------....... DATE..... ---------------------- REVIEWEDBY--------------------------------------------- ----._ DATE-------------------------------- ..............---------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----•----------------------- -------------------------------- ------------------------------------------------•------------------------------------------------ ----------------------------------------•--- -----•- ------•------------------------------------------------------------------------------------------------------------------------------------ ----------------- ------------------_--- ---------__. ------- - --- ----------------------------------------------------------------------------•----------------------------------------------------------------------- --------------------- -------------------------- --------------_.----------------------------------------------- --------------------------------- 51 FINAL INSPEC ' Date---- -------- ,T - -. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 95 9 REVISED B-59 3M 3-'63 F.P.CD.