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FOR OFFICE USE: , ---- --------------------------- -: ---- ------ ------------------------------------- s _- APPLICATION FOR SANITATION PERMIT Permit No. ....... �/ ---- -- -------------- ---- --- --------- ----------------- . _ {Complete in Duplicate) - _ _ � ,.T4. Date Issued ------//-----�� ---.,--_----------------------___....___._--------_..__. This Permit Expires 1 Year From 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- '- JOB ADDRESS AND LOCATION----- Z-- ----------- b--4...... ._ ---------------- ---------- Owner's Name ©------L _ ----- Phone ---------- Address------------ -----------------------------------------------------------------------------------------------•-•------•----- ••-•--•-- --------•------------•-----------•--------••- Contractor's Name-------- '---------------•-•------- ------------------------- ------•-=------------•-•---------- --•--- Phone----------------------------------- Installation will serve: Residence CK Apartment House F1Commercial ❑ Trailer Court E] Motel [IOther ❑ Number of living units: -A___ Number of bedrooms J___-Num6er-of baths--4i_ Loi size _____________.----__ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table 10- ft. Character of soil to a depth of 3 feet: Sand n Gravel ❑ Sand; am ❑ CIay1Loam ❑ Clay ❑ Adobe[K Hardpan ❑ Previous Application Made: (If yes,date._._IRA.1----) No ❑' New Construction:1Yes E& No ❑ FHA/VA. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Eli A (No septic tank or cesspool permitted'if rpublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_---------------Distance from foundation----------------------Materiai----------.-------------------------------------- N8. ___._:__..______________._..____.__.No. of compartments----------- ------------=Size---------------------?----------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well._n0_KS,_Distance from foundation_1_1_CP1 ____.Distance to nearest lot line_____-5_/___- I %,Ey,t6t% Number of lines----- ______________________Length of each line_______: .'S___�- Width of trench-_-------24.-�___-_____ „Type of filter mate'rialA-1-f-ptik-rock Depth of filter material___,_ 1_ � _ ir1 dotal length___.____ ,S_._____� -�_ � � Seepage Pit: Distance to nearest well----- _____.:Distance from foundation= ___------_1____.Distance to nearest lot line_____ __________ lU ❑ Number of pits------ ----------------Lining material-----------------------Size•:Diameter-----------------------Depth.......-------------------------- N Cesspool: (Distance from nearest'welL______________`bistance from foundation. --- Cesspool: material----..__________._---_-___-___-___.__. N ❑ Size: Diameter------ ------------- --�"`Depth-----------------#----------------- .. ------------Liquid Capacity------- --------------------gals. i t Privy. :..Distance from nearest well-�.----i__________;___.-_--------_--------- ___Distanca•from nearest building__{__._.--.- _______.____. Distance to nearest lot line_--.___�-�__-�---r__�_°_.___._. E � f 1 y0:"" ----------------=------------------------------------------------ --------------- ----------- Remodeling and/or repairing (describe):._-____ �t u ----•--4AZB -1-' -------t6------- - 1 � -1-� r--------- ------ 1 - _-_..-------------------------------------- ----- -------------------------------------- --------- J + ti it ---------------------------------------I --------------------------------------- - !v r ------------------------------.---------------------------------------------------------------=------------------------------ V+ 1 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-and regulations of the San Jin al Health District. _ LLoc - � . � --- ------ .-•-------- -------- (Owner and/or Contractor)(2 --------- - IBy:------ ------; ------------------------------------- ---------- ---- ------ ------------------------------------ -----(Title)--------------------------------------------------------- ------ (Plot plan, showing size of lot, location of.systern in relationtto wells`,,btiildings etc.,can be placed on reverse side]: 1 i � FOR DEPARTMENT USE ONLY < APPLICATION ACCEPTED BY----- Q---- -------- ------; ., ------ DATE------ ' ' I ' REVIEWEDBY-----------=------------------------------------------; ------ ------- DATE BUILDING PERMIT ISSUED - - DATE i Alterationsand/or recommendations:-=-------------------------------- ----- --------------------=-----•-----------•------------•--•-•------------------------------------------------------------- ----•---------------- ------• -------------------•----------------- ----- ------------------------------------------------------------• ---------------•---------------- -••--------------------------•-•------------ t ------------•------------=--- ------------------------------------ ------j------------------------------------------------ i --------------------------------------------------------------- ----'---------------'----------+y---------- ------------------•---------------------------------`---------•---- ------------------------------------------------------------------- F1NALfNSPECTION BY -------- -' �=�-------------------- --------- Date r----------- ------ ---------------------------------------------- SAN JOAQUIN LOCAL`HEALT.H'DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i ,SCS 9 REVISED 8-59'3M 3-'63 F.P.CC. 1