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' - FOR OFFICE USE: -O----------------: ------------ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicated 1 _ ___ __ --------------- This Permit Expires 1 Year From Date Issued 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. 549. I --- -- -- - ---- s1Q ~ ��lcJ. JOB ADDRESS AND LOCATION - .. . . --------- v....... f� F Owner's -.._ � " `'�" .. ... ----•-•Vr----- ••---- --- •------------- Name Address............--•--•---------_--•------ w""'` ,`-----------•----------------------•-------------------•-----------------------------------------•-------•-----•----•-----------•- Con#ractor's Name................... ...... z •---- - ................... Phone................................... Installa+ion will serve: Residence J4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/ Number of bedrooms 3_. Number of baths /-- Lot size ----------------=-- Water Supply: Public system PT Community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 fee+:- Sand Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe E] Hardpan C1p �] -' Previous Application Made: (if yes,date.-----...__.---..---) No [J—New Construction: Yes ®—No ❑ FHA/VA: Yes ❑ No G_� TYPE OF INSTALLATION AND SPECIFICATIONS:�,, � ` I (No septic tank or cesspool permitted if public sewer is available within 200 feet:} k Septic Tank: Distance from nearest well----------- --Distance from foundation__Z. Material... No. of compartments---------- Size-- . .`,---------.- -----Capacity------._..Y_ .t--X_a'Li uid dapth f Disposal Field: Distance from nearest well---_---r�t_Distance from foundation------Z�v.....Distance to nearest lot line_---•_. Number of lines-'______________ �-}---Length of each line.---_---_.-.--�ct......Width of trench--__.__-----_z --_------ SeepagePit: Distance to nearest Iwlell_-___„�.r__---Dep}h of filter material__.��-'�...__Total length--------------------��-__._..__.. Yp � -- ----Distance from foundation.._.__. d.._.Distance to nearest lot line------ .. Number of pits-- -_-_-_ ---.Lining' Site: Diameter.- r _-`r-_..Depth_--.....-2 +i ----- Cesspool: Distance from nearest well----------- ----Distance from foundafion'_A----- ----------Lining material--.-......----------._..------_-__-_. ' ❑ Size: Diameter--- ---------------t---------------#---Depth----------•--------------------------- --f---------Liquid Capacity----------------.-.------..gals. Privy: Distance from nearest well- - ---- -------------------------- -----Distance fromnearest building---------------._--------___-------------. ❑ Distance to nearest st lot line----------------------------------------------------------------------........-----------------------------..----------------•---------------- Remodeling and/or repairing.(describe):--- =-_- ---- - --- —2------ ---------- -------------- --e......&---F..__--- r-I ------_�'� �a�` r/ �� l'E '`- -'•-•• --- ---- iartify - --------------- � --- -�- - I eby that I have prepared this application and that th work will be done in aeEordance with San Joaquin Cou ordinances, State aws, and rules and re ulations of the'SenTJoaquin Local Health District. § I �c {Signed}------------- -j .tet ,'-__._. ": (Owner and/or Con+ractorK Y. ) �- (A0_ Ti+le {Plot pia wing sire of lot, lata#'n-of syste, ,In relation#o wells; buildings, etc., can be placed on reverse side. R 7 V .j DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ °_ t ' �.€'t�. ------------------------ ------------------ DATE-----------••-•--- t C 'Z REVIEWED BY----------------- •------------... " = `-------------•-�-------------_- DATE----------------------------------------------------------- ------ -- DATE------------------------------------------------...--------- --- _ BUILDING PERMIT ISSUED....-----__ -------- ---- - . f `} Alterations red/ r recommendati ns'..Y_-.-----._.----_-.-- ---_ -- S- . .-- ...... -- {, ,t�� .--------!-- -- - -- -- : . .--------- � /---- 4 FINAL INSPECTION BY:..-•- --1 • 7 -- ------ Date------------ L - .-C--------------------------------- 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 8-54 2M 5-62 ATLAS