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FOR OFFICE, SE / r , ----- ----'ter - ----- ZPPLICATIC N FOR SANITATION PERMIT Permit No ... - -- _ (Complete in Duplicate) ------ 7��Y -� __._._ This Permit Expires Year From Date Issued Date Issued _________ ______ __ 3 --------------- --- ---------------------------- 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;,wiithh County Ordinance No. 549_.Q JOB ADDRESS A OCAT -----C�-i--r---D�---------- /i7?DGt:-G!_--rL -- ��------------------------------- •--- .. --- Phone ------------------------ ------ Owners Name.! - -----D--tee--f- ---• .. Address -• -- .......... -- - --�-/ �._ -------------------------------- - ; Contractor's Name------ - - ----------•-- dE ----------------------------- -------------------------- ------------- ---- Phone----------------....-------------. �' Apartment House Commercial Trailer Court ❑ Motel ❑ Other ❑ I Installation will serve: Residence Apace ti.,� NNumber of living units. ___ . -_ Number of i edroom - Lot size ___ __ ----- umber -___-._ Number�of�bafh�_ ,� --,�-��-v------ -- - Water Supply: Public system,[] Community system 0 Private ❑ Depth to Water Tab Character of soil to a depth of 3 feet: Sand*[]NGravel ❑ Sandy Loam ❑, ClayrLArn ❑ Clay [I Adobe ardpan El Previous Application Made: {1f yes,date_.---._ --------l No E " New Construction: Ye&l N. ❑' FHA/VA: Yes 9} No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if:public sewer is available within 200 feet.) � r , ----------- Septic T Distance from nearest we,117�!:'�-Distance from foundation__I-----------Materials-��._. YIL� i uid de th_______ - -__Ca acit') No. of compartments-------- q p. -- - P Y- ------ --- ------ � I � 1 '0 Disposal Field: Distance from nearest well----__.`--.._Distance from foundation___ _ Distance to nearest lot line__________. p --;�---- 1 , /� �^ Number of lines_______ ._: ----....___Length of each line_�_j— _ /r_��.� Width of }rench�_y_ ____________________------ ------- ___ Type of filter material_-t--__..__Depth of filter material___ 6_ --.----Total length -�______________________ a 4-_�_-.___.Distance to nearest lot line-______________ 1 Seepage I : Distance to nearest ell-,__ _____- Distance from foundation__ ' � Number of pits-------r 'Lining material-- G- ___-.Size: Diameter._.. �..._�..__ Deptn/�D__ W ° Cesspool: Distance from nearest well_-------------Distance from foundation----_._.___.__-___.Lining rnah'eria!__._.._______-____________________-_. ❑ Size: Diameter �� De th -Liquid 1 apacity gals. p 9 Privy: Distance from nearest well---------------- --------------------------Distance from-nearest bui'ding-------------------------------_--_------- ❑ Distance to nearest lot line----- ----------------- ---•- -- ----•----------------------------------------- Remodeling and/or repairing (describe)____________>-n- _- ____ ---- -----. -1 --•----------------------------------------- lE --- --- ------------------------------------------------------------------------•----- -----------------------------------•-'•------t-•-•-----•----- ---- z ------------------------------------------------------T---------------'----------------------------------------------------------------------••--------------•----------------'--•-------------------------------------------- I hereby c . 'fy that I have prepared this application and +hat the work will be done'in accordance with San Joaquin County ordinances, S to ws, a r s nd regulations of the San Joaquin Local Health District, (Signed)-•- --- -- ------• a- - - ----------------------- --------------------------------------------------------------------- = Owner and/orContractor) --------------------------------------------------------------- (Title) ! (Plot plan, sho n size of lot;location of system in relation to wells,.buildings, etc.,,can_be placed on reverse side). � i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----- ---- -- ------ -- ------------- ---------------------------------------- DATE----- AA-J-----7� _�---- REVIEWEDBY------------------ *------------------ - ------------------- -------------------------------- DATE----------I--- ----•-------------------------------------- BUILDING PERMIT ISSUED-------------------/-o.��- - � - �----- DATE------- -- �- - -- --- - ---------- --•---------- Alterations and/or recommendations:--------A---- ----"Q "Y ------------------•-�---- ; = j 5 ---------------------------------- -- ---- - . -------- _ ----------- -------------_________________-------------------------------...__ - _ ----------- -------- ,„'FINAL INSPECTION BY: f - ----------- Date------7- / --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California FS 9 REVISED B-59 3M 3-'63 F.P.CO. i