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R OFFICE USE: - ^-�-wM ------------ r 11�� _________________/r.a a--- APPLICATION FOR SANITATION PERMIT Permit No. .:7`� ------------------------------ ---------.-.----- w (Complete in Duplicate) t, ------ -- -------'-- ------ 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. JOB ADDRE=SS AND LOCATION__2 S . -— --- --- ---------- ----+-------- --- ---------------------------------------------------••---------------•---•------------ - -------- --------------- Owner's Name_---a,----- •-- •--•-- ------•------ ------------------------------------------------------------ Phone_.. Address-------•----------gAll-A _ - ------------------•-•• Contractor's Name -------•------ -it. GL----t/ Phoney lr_-. 3/� Installation will serve: ;Residence Apartment House•❑—Commercial -p "Trailer Court[] Motel '❑- Other❑ Number of living units: _ - Number of bedrooms _.2--_ Number of baths _- Lot size ----6-Al...... Water Supply: Public system gCommunity system ❑I Private E] Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [-) Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan [] Previous Application Made: (If yes,date-,.1. -1---__bNo B'O*� New Construction: Yes ❑ No [Er" FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is T nk: Distance from nearest well________________Distance from foundation--------------------Material _______.___.__________________-_-._ No. of compartments------ -•-----------------Size----••-------------------------Liquid depth---------------------------Capacity-------- _------------ Distance from nearest well_A-0a-__Distance from foundation___,l_0.._-------Distance to nearest lot line----$_.-_-"___.. Number of lines------ Length of each -----------------Width of trench.____0?:_4�-"__- ----•------- Type of filter mate rial_s! _PCk_--Depth of filter material �_$__�� Total length______--._____}___3.D_'_- Seepage Pit: Distance to nearest well�#)-L--_____Distance from foundation---/___t!?_-_____.Distance to nearest lot line__.__�__.._N + [r Number of pits___,./_________------Linin material_ et_._ p ------------------ ------- Lining ._$ize: Diameter_ . +' Dept ,rZ-S--- ----- Cesspool: Distance from nearest well________________Distance fr`om'foundatio'n._7:-__`_--Lining material-_____-_______.___-------------------- F Size: Diameter--------------------- --------}------Depth------------------------------------------ - ------Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------ --------= a Remodeling and/or repairing (describe)______________ # ---- --------------- -------------------------- - I -----------------•------------------ Al f • --------- ------------------------------------------------------i------------------------------------------------------------------------------------------------------------------------------ `-- ---------------------------- I hereby certify that I have prepred this application and that the work will be done in accordance with San Joaquin County i ordinances, S ate laws, and rules a d:regulations of the San Joaquin Local Health District. (Signed)--- ----------------------------- -------------(Owner and/or Contractor) BY [�c/�------------------------------(Title)-- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed reverse side). t € FOR DEPA TME T U E ONLY APPLICATION ACCEPTED BY _� :_ -___ 00, DATE_._____ -- • - ----------------- REVIEWED BY ---------------•--------------- ------ ----------- --- - DATE__ BUILDING PERMIT ISSUED--------______________________ 1DATE _ a Alterations and/or recommendations:_____ -------•---------------------------------------------•--- ------------ ----------•------•-------------- --------------------------- ------- ----------- -- -•----- --------- FINAL INSPECTION �------------ . Date--.- _j Qv ��--_�. _�------ ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 3M 3-'63 F.P.CO. r