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FOR OFFICE USE: ----------------- -------------- ---------------- `, --------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. .. _G•_ 3`� ---------------- (Complete in Duplicate) Date Issued _ -1_- ........... r� ----------------- --- ------------------------`' _ . ............... _11 This Permit Expires 1 Year From Date Issued Awl , Application is hereby made to the San Joaquin Local.Health District for a permit to construct ancl install the work herein described. This application is made in compliance with County Ordinance .No. 549. , JOB ADDRESS AND LOCATION----4?-a,1,a, -------!7;2, r'' '` - .. _�.______ { Owne`r's'Name-------- L jj rva�r.- - Phone dr =� �� . Address • - ----- - "�- ------ ------ - --------------------- - Contractor's Name ---------------------•-"------------------------------------------------------------- . Phone------------------------------------ Installation -------..-..--- ---- ----- - Installation will serve: #Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L.---- Number of bedrooms - --- Number of baths l-_-._ 'Lot size _- -0'4 - _ --.-_-------------------------- dd Water Supply: Public system [:] _Community system El Private aI Depth to Water Table .70- ft. s l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam B 'Clay Loam ❑ Clay Ep Adobe❑ Hardpan f Previous Application Made. (If-yes,date-- ------------ ,No�p New Construction: Yes. No ❑ FHA/VA: Yes ❑ No ❑ ' TYPE:OF INSTALLATION AND SPECIFICATIONS: -+ : :(No septic.:tank..or,cesspool permitted if public sewer_is,available-within�20.0 feet.)» -�-- - -- -• -�- - Septic Tank: Distance from nearest well--J--O--'---.Distanc%'from ounclation-- 0- Material--6&'? - ---- No. of compartments----_ ----------- depth--------V---------------Capacity-/,?-0-70------- Disposal Field: Distance from nearest Distance•from,foundation;_-� -- .....Distance to nearest lot line-S-/_-------- [ J Number of lines_-_.-- ---..--. -___-._-_ __Length of each line----- .---_----__.-.-.Width of trench..... �-;� j -------------------- Type of filter mater•ial�_L "<�L -Depth of filter .material---/._��'---`-_.-Total length_-., - --:-------------_- ------ 'L Seepage Pit: Distance to nearest well--/.------------Distance from oundation-1 _`_-_------.Distance to nearest lot I e- ------------- F Number of pits:_...............:Lining material_/L,__- .--.------- Size: Diameter----- Depth_,-z'_-_._.__.__________________ ' 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-----...---------------__-----..--..---.-. i ❑ D.istance 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 an ulations of the San Joaquin Local Health District. -.- -•-�y..� ter. � -.r+-?-.- — -.�a - ."�.. -N ;.- (Owner and/or Contractor)r�(Signed) ------ F � ig - ---- ------ -- ------ TT ------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY AV APPLICATION ACCEPTED BY-- �' - DATE �f 2' f f ---------------- REVIEWED BY---------------------------------- ----- ------=- ----------- -------------------------------------------------------- DATE---- ------ ----------- - BUILDINGPERMIT ISSUED------------------------------------------------------------=---------=-----------------------------= DATE--------------------- : Alterations and/or recommendations:--.:------------------------------------------ --- -----•-•--------•--------------------•-----------=------------------- ---------------------------------- ----- -----------•--------------+--------------- - #------------------ ------------------------ -------------------- - - --------•-------•-•-•------------------------------ ----------- I ------ -----------_-------------------------------------------------------------- - k y ------------------------------------•------------------------------------------------------7-------------------........----------------------------- NBY: �- � ..-. --- --- ------------------------------FINAL INSPECTIO - ----- Date.... __ 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 CS 9 REVISED 5-59 3M 3•'63 i.r'-CC. . � 3