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FOROF CESE: o y� / _ 3 APPLICATION FOR SANITATION PERMIT Permit No. ...��a �Q. J��3 (Complete in Duplicate) -------�-- --- --- ------------- Date Issued .-��f•� t ------------------- ----3.r-_ 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 install-the work herein described. This application is made in compliance with County Ordinance No 5 JOB ADDRESS AND LOC ION._..Cl. /� Owner's Name............ ••.•-- •• ' ------• - - - ---------------------------------------------------------------------------- Phone---•-------•---•- . ---------•--------- Address------------------- -- Contractor's Name............ --------------------------------------------------------------- Phone................................... Installation will serve: Residence partment Houseommercial E] Trailer Court Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms -_'Number of baths ..7-. Lot size _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -lardpan ❑ Previous Application Made: (If yes,date--------------------) No W�-- New Construction: Yes ❑ No UR-' FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i ,�" Septic Ta ,,3 Distance from nearest will_____—_-Distance�ncefrom foundation__/_1r__ -.Material----6 -c'�AKAe*�-____. ,3 %A No. of compartments_ _""' -7 _-Size4ot_+�_�,,i,,�� .� �iquid depth____ �__-- . Capacity, .__^-_- Disposal ield: Distance from nearest well ----_Distance fFom foundation.../0-__--___.Distance to nearest lot line.' ,r� -- [40 �, Number of lines-__-___ems-__-_ g ^P. _�__ _ ______ en th of each line__ __ _ _!____________.Width of trench._y;._._._,...__`_.,_______.__ Type of filter material; CAepth of filter material----14r ....Total length------- ........... Seepage Pit: Distance to nearest well------ -_.-Distance f m fou dation___ f� Q.!_..D t nr�e to nearest lot line___ _�__�_.. [ Number of pits-----;L_._-.-_--_.Lining material. IV Size: Diameter__ ----_-:_-_-Depth�.s�_._ ................. 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------------------------------------------ F] ___----_-__--_--!--•.-•_--___-__.- --.❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------0?,n---------i/--X--" - --- , 4;0-------•----------•------------------------- 004 a --P.------------------4--1---------� � '`�'.--------,lbw,--�`�` _ 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 r es and regulations of the San Joaquin Local Health District. (Signed) - - --- - -------------------- ---------- ��-------- ------ r Contractor) By:............................................--------- -----y (Ti+le) /1�E�- •- -- ------ - - ------ ---- ------ - (Plot plan, showing size of lot, location of s min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ---------------------------------------------------- DATE--------- --------_--------- REVIEWEDBY-------------------------- ------------------ _--------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations: - - 7-Via- .�- - G c�' ------------- �^ - - -------- -f-'�--------------------------........................... --------------•--- . --/ .G ..ri ------------- --- FJ G� e�tr, - ..40 '�/� ,.� FINAL INSPECTION BY:. Date------= 1.2: ---------------------------- ��o 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 ES 9 REVISED S-S9 3M 3-'63 F.P.CD.