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FOR OFFICE USE: ' T -._--.-.------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .•1.313.D__ ---•-----------------•----------------------------------- (Complete in Duplicate) t �S Date Issued ... ............1- ..�--- This Permit-Expires 1 Year From Date Issued f 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. 549. toANT-E- 3-08&D D R E S S T-E-JO&DDRES5 AND LOCATION ....... -------NoRTH------.As_�!------ � 3. Owner's Name------. t1.�- L Tfl1� }�'] --------------------------------- ---.-.----------------------------- Phone-•..........--••.................... Address............ ' �: : G's 7 �'� ��`Ix.. f . �: _ t 1- + ----- ---�. Contractor's Name... ..-- ' ` .............................--------------- Phone.-..__..-------- ------- ---•------•--------•------•----------••.............•----._._. .......-•---------- Installation will serve: Residence ff 21--Apartment House E3 Commercial ❑ Trailer Court ❑ Motel,❑ Other ❑ Number of living units"',_. �s -!_--- Number of bedrooms Number of baths I-.... Lot size ..__... ,� ... }C �-_--------------- Water Supply: Public system E] Community system ElPrivate Depth T Water Table . ._ ft. i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________J No 0New Construction: Yes Ea-'No ❑ FHANA: Yes ❑ No 8 TYPE OF INSTALLATION AND,SPECIFICATIONS: . (No Septic tank or cesspool permitted if public sewr abil within 200 feet.) P Septic,Tank: Distance from nearest well____ 4-Distance from foundation---f0..........Mtarterial-__,gfFpi�V02.0............. F No. of compartments----_-_ ____. .)_Size__ - _X_ Liquid depth....y---------------- Disposal ----------------Capacity__. ___•_• �, p well F__ -Distance from foundatio /0.-......Distance to'nearest lat li e..._- -_--•i7 Dis oFieEd: ---- Number of lines eares �_- Length of each line---___ ..............Width of trench-------- ��`j _-_- �i --- Type of filter material.....- Depth of filter material......-1�_`_r._Total len th_-I±!_------- . � Seepage Pit: Distance to nearest well--_;,/--------------I.Distance.tfrom foundation___-__--______--._..Distance to nearest lot line-___._-_.._----._ ❑ Number of pits................./....Lining material-."'--/....... -.---Size: Diameter-----.------------------Depth................................ . � I Cesspool: Distance from nearest well----------------Distance from foundation-------.--------._-.Lining material_.----------------------------------- Size: Diameter--------•=/---•-------------------�-De th.-:�-_----------�------ --.Li Liquid Ca aci-` � p i ------------------------ 9 p tY------------------------._gals. i .. � Privy: Distance from nearest,.well111--------------- -----__-____----_ -_.-_ __Distance from nearest building--"--..-.___-_----___._._..-------__-__. ❑ Distance to nearest lot line ' ----------------------------5-------------------------------------------------------- ------------------------------------ I Remodeling and/or repairing (describe): --------------- --------•----------•--------•----•-------------•------- --------------------------------------- _....-_._-...-._-W,.. ...-.moi.......-... � � .. . � ....................................-...............-_.----------........----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ hereby certif at I.hav i prepared this application and that the work will be done to accordance With San Joaquin Caun 4 ordinances, Stat an- r es and regulations of the San Joaquin Local Health District. } (Signed)------ ---- ------ ------ ----T�---- - 1 '- ------------------------------------------,._----:---------- -- ........._._---•-----(Owner and/or Contractor) By:...................._......L.:-------.............. l --.....--------- ----------......---•--.... ....................Title (Plot plan, showing size of Rot, location of srsiem in relation to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- = `---r-------------------------------------------- DATE =� `-----------`----------------- REVIEWEDBY------------------------------------------------------------------- ..............................-DATE-__..........................• ---•--- BUILDINGPERMIT ISSUED---.----F---------------------------------------------------•------•----•-•.......................... DATE-------------------- ----- A terations and/or recommendations:--------------------------------- -E 4 1 --,-l �' ---------------------------------------•-------------------- ------ ---------------------------------------------------------- .....---•--......-------•----•--------------------------------•-------------- ---------------------------------------------------•- - ------------------------------------------------------------...----------------------------------------------------- -- ---------- ---•-----------..... -- -- ----- - -------------------- ---- -- ----------------------------..----------------- -------------------------------------------------------------- FINAL INSPECTIO -- ----- •---- , Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5.62 ATLAS n