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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Nod' . --_-------------------------------- i' -.." ----------------------------------------------- --------- (Complete in Duplicate) ` ------------_......_______.__._.___- ----- -------------- This.permit Expires 1 Year From Date Issued Date Issued .._.________/__ �1 ' 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---------360--Y.....7th, tTeet. ------- QC _!?Ck----------------------- -----------------------------•-••------------ Perr Torr® __ T-orrez_�..-.• =--------------------•-- ---------•--- Phone-•--HQ•.. - -_.`�' Owner's Name------------------------------------- ....._.... --y--- �. Address----------------------------------------- ----$alnQe........ -----------------------•------------------•-------- Contractor's Name---' e---DAY--&--NIGHT._5_e.p_tile..❑ank__Smc-.---------------------------------------------- Phone---- 9...673—a42----- Installation will serve: Residence3a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1___ Number of bedrooms _2____ Number of baths _I___ Lot size __3.Oj___X---125_r______________________________ 'i Water Supply: Public syserr>'4& Community system ❑ Private ❑ Depth to 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--------------------) No ❑ New Construction: Yes ❑ NoIX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation______________=.__.Material_______________._____________________.__________- ExisMingNo. of compartments------ -------------------Size----------------------------.:_..Liquid depth--------------_---------Capacity------------- ------•-- Disposal Field: Disance.from,nearest well---KQMe---Distance from foundation...10=____.._.Distance to nearest lotline____ i ExisEing Number of lines------I------ -------------------Length of each line--------10 t------------.Width of trench_____21-0----------._=-------- - . rr_ & ADDS' Type of filter material_.._.S_ep_t-c-ptof filter material----la_____________Total length___._____1Q_____.____________-___.__ W Seepage Pit:., Distance to nearest well___-�TQM------Distanee from foundation___,101________.Distance to nearest lot line______5_________ x] Number of p;fs.--.-1--------------Lining material---RQck--------Size: Diameter-_3311-------------Depth------;x.5.1__----------------- Q ;Cesspool: Distance from nearest well_________________Distance from foundation-----------___:Lining material___...____________-___--__-__----__. t ❑ Size: Diameter__.`r----- --•----------------------Depth----------- =`---------------------------------Liquid'C+epac�tY -!gals. i� Privy: Distance from nearest well____---.__ �-_- -`________________-.._-_Distance from nearest building__'__.._____________.___._____-_--.-_.._.. ❑ Distance to nearest lot line----------- ---------- ------••------------------------------------ ,J Xi. , ,f Remodeling and/or repairing (describe):----------------- ------------------------------------------------- ------------------------•--------------------•----------------- ----- •--. A __S_UFPIEMENT.&RY-_DR.AINAGE.-------------- --------------- -�--------------------------------------------------------- f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - - The DAY--&---NIGHT----`------pti--- --- _.St 'V � f Contractor) r (Signed)------- { I By:---------------------------------------------------------------------= ---------------- `= �-------(Title)------------ , (Plot plan, showing size of-lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). :. A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_---.__.__ __ ,-� _ DATE_______ ..: 1 _. '--___-. REVIEWED BY-------------=----------------------- -t- ----------------- --• ------------ DATE------- ------------------------------------------------ -------------- BUILDING PERMIT ISSUED________________________ ___ Alterationsand/or recommendations:_i------------------------------------------- -----------•------------•----------------• -------------------••--•-------------------------------------- -•---------------•------------------- -----------------------------------------------------------------------------------•-----------------------------------------------------•----••-•------------•----------------. -----------------------------------------------•------ --------•-------------------------------------------------------------•-----------•-----.---------------------------............--------------------------------I— J� _________________________--------------------------------------- ___ __ _ --------------------------_--------------------------_______________________________________________ _________________..___ _______________._____ f r FINAL INSPECTION BY:.------- -•----------------------------------------- Date X�------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street "i 300 West oak Street 124 Sycamore Street 205 West 91h Street Stockton,California 4 .` Lodi,Californla Manteca,California Tracy,California a —Etir9 Rewa Eo e•69►.P.co.a.6.60