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R OFFICE USE: i APPLICATION FOR SANITATION PERMIT Permit No. -------- -- --- -- --- [Complete in Duplicate) �1 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 .----_----------------C�r •- ----`-�:--•• -�%/ C'iC/--/,�c�==----------------------------------------- _ Owner's Name------- � x LAG kf�/ -------------- Phone `:? Address--------•-•-•----------•-----------rfSZ_)?-2 ---- Contractor's Name , / 1�� / -------------------------------------------------------------------------- Phone_��id�3;_ e-,-----... Installation will serve: Residence q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _`:_--.Number of baths __ ___ Lot size _....!s-� _._.K_/Q -------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Ap__ ft. ` Character of soil to a depth of 3 feet:, Sand.❑.,Gravel ❑ , Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jjT Hardpan ❑ Previous Application Made: (If yes,idate--------------------) No New Construction: Yes ❑ No,W FHANA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS- s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation---------------------Material------------------._--_-.._-_-_---------_._--_-. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity.....---•-------- --- c Disposal Field: Distance from nearest welMe.iLCL-Distance from foundation-__-1.0..`......Distance to nearest lot line-----!T_'_____ �..�;. P � J, Number of lines_:_____:`-------------------------Length of each line---------2�-1-..---------.Width of french---------2K"-.-__-_.---___- e Type of filter Depth of filter material---_._Z-�'------Total length------------------- _1�-'---------_-_- Seepage Pit: Distance to nearest well_'2d-rvf___`_Distance from foundation___---lf _'___.Distance to nearest lot line----1-_.`--__.- Xaj4 Number of pits_____/'_'______—Lining materiaSize: Diameter____-- Thi__Depth------.,-e.?_;�=__-'_____________ Cesspool: Distance from nearest well----------------- from foundationd _____.________--__..Lining rimaterial__..__-_--__-.-__-_-----.__._--__----. % 00 171 Size: Diameter = �._ v.�-.,.. �. _ Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------ -------- -------------------------------Distance,from nearest building-----._---------__-_----_-----..-----__--. ❑ Distance to nearest lot line---------------°----------- --------- -------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----. mac .1_C' __.e_s! 1._.2Z,41e_-__-_! --- -----------------------------------------------------------------------------------------------------------------------------------------------= -----------------------------------------------------------------------------------------------•------------------------------------------------------------ - ------------------------ -----------------------------------------:------------------------------------------------------------------------------------ I 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 Joaquin Local Health District. 1 (Signed)------------- / '�� ------- ------ .---x------_-_-- -_ _ ________ Owner and/or Contractor -(Plot._4-- ------------- ----- ----- ----- -- ---- - - - Title By:-------------- -� - . - { { -- ------------------------------------ (Plot t plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY. I APPLICATION ACCEPTED BY-----------------�r.-- '� - ------------- -------------------j DATE ='=��` REVIEWEDBY----------------------------------------------------------------- - ------- ----------------------------`-------------`-----= DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------------------ - ----- -------- -DATE--------------------------------------------- - ------------- Alterations and/or re mmendations: ----- ------------------------------------------------- ------------` ------- ...-------- •-------------------- •------------------------------- ------------------------------------ lrl i t ------------ ----------------------------------------- ---- ------ -- ---- -------------- ------------------------------------------- ---------------------- --------------------------- ---------------------------------•-------------- ---------------------------------- ----------------------------------------•---------•---------------------- t . _eFINAL- INSPEC !ON BY . Dt SAN JOAQUIN LOCAL-HEALTH-DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street . Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVl5ED B-59 3M 3-'63 F.P.CD. f