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�� Id F/ �,j FOR OFFICE USES � , �------� � �3 l--------- x. Permit No. APPLICATION FOR SANITATION PERMIT ........ + ---------------- (Complete in Duplicate) Date issued . ,p This Permit Expfires 1 Yeas From Date Issued '`��,pp cit on s hereby ma a to a "Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in.compG ce with County Ordinance No. 549. S �-------S�----------- x o � � ..:....... ............... JOB ADDRESS AND LOCATION_ _. .� --------- P one a 7 Owner's Name____. --"- T-------- .• ------------•--------.................................. `- ,Addre55. _ _. r.; Ph--;--------- .......................------•-- -•---- -------_----------- F a one..-•----•-•• ••--------•--- ! I E contractor's Name........ ------Ole l�3=��--------------•-•- - �;, t--.� Commercial 'Trailer Court:, Motel ❑ Other C Installation will serve: Residence Apartment House ❑ ❑ ooms Number of bath --s -::- Lot size`.----- .e -..x.- ............. Number of living units: __. __ mbar of bedr �. Water Supply: Public system Community system ❑ Private [j Depth to Water Table------_-_ ft. r Clay m e Adobe Hardpan ❑ epth of 3 feet: Sand ❑ Gravel I-] SandyLoam ElCly Loa ,ClY ❑ Character of soil to a d Previous Application Made: (if yes,dote--------------------) No (3 New Construction: Yes� DYes ❑ :No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'ter ` Material------------------------------------------------- No. -----•----••--------------- ----------------- l Septic Tank: Distance from nearest.well_________________Distance from foundation.___-_____..___._ _. 'Capacity.. Liquid de th--- •------------ -----............... ❑ Q,,.�`� No. of compartments-•------•----------- -----Size--------•---------------••----- 9 P. T �+-Distance from foundation...2 _-—-:. Distance to neerest,lot Disposal Field: Distance from nearest weH../.�(?.,_-- _ rr Number of lines____ -------------------------•-•-Length of each line..__ Q--• `-�YWidth of trench • --- "`ra Type of filter mate riaL_Z_O_C—K.----Depth of filter material ----[ _.____ Totallength__:.._. -- See a e Pit: Distance to nearest well----- =--.Distance from f undation_---_V-_-..-.Di�ancet o nearest lot'line_..._ f.. p 9 -------- -Lining material_- -- . ._ $ize:-�Biaeter---•-- X h d3 ❑.��" Number of pits.---------�•----- - •--- �-`-- =----�'eiT� � - � �� Distance from nearest wall_'_.=__.___'.:_Distance from r Cesspool foundation---------------_--Lining.mater;ial............_.__----:-----------• --- ❑ . itY Size: Diameter----- 1-------------- vh _-4____ _Li uid Ca ac ......gals. Distance from'nearest building_____-------------------------------------- Privy- ___________•----------------- --. Privy: ----------•------ � ___ Distance from nearest we ....:........ -•- Distance to nearest lot line '� Remodeling and/or repairing (d scribe)----------------------- - - ------------------------------ - ----- • .•------- • ----- ----- -=-- --------------------------------------------�------------------------------ - I hereby certify. that I have prepared this application and that the work will be done in accordance with San Joaquin County k ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. f (r (Owner and/or Contractor) (Signed)_ - By:------------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------------------ -- (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 ' APPLICATION ACCEPTED BY___ --- DATE____ _:.J.l -.:`.lam --- --- ------------ --- ------------------------- ------------------------------------------ REVIEWEDBY------------------------------------------ ------------------------------------------------------------•------------•----- DATE------------------------------------------- --------------- BUILDING PERMIT ISSUED-------_--------- ------------------ ------------------ �J -------- DATE--------------------------------------------- ------ � �rrr G -- AFferations and/ rec mmendAtions:'r;_ --- ... _ - •------- �. . _ •`.- -xP � s x= /� c --------------- . Date------------- `" �'�j//---- AFI�NAL INSPEC�'10N BY:.---------- - - ----------- ---- -- - - "u f / SAN JOAQUIIN L I AL HEALTH STRICT 124 SYcernom Street. .. 405 Wait 91h Street I .130 South•Ainaric6n Street __- 300 West Oak Street . Lodi,California Mantua,California Tracyr California r Stockton,California {• ES 9 REVISED 8-59 2M 5-61 ATLAS