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FOR-OFFICE USE: . ----- ------------------------------- -------------- ------------ ---------- APPLICATION POR SANITATION PERMIT Permit No. P 3/ � ---- -------- --------•- - ---- (Complefe in Duplicate) - This Permit Ex ires 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. ,. ; r r JOB ADDRESS AND LOCATION_1__ j6- ._ ------- Owner's _ - _ Owner's NameCf --I----- -_- - ` - ------ - - _ Phone -- 31 _�f( p� j-f-Ci9 Address----!-.3 I I� �-- �� Contractor's Name ' } ------- --------- Phone----------------------------------- �. - -------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __ _�_-#Number of bedrooms ---o�-- Number of baths._-/-- Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table - ft Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam 70 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yesrdate------ _---------- ) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well---- QQ----Distance from foundation-----q!P.--------Material ._-rQN4'-�-�_`�-±�--- iz.Q0566$ No. of compartments-._----.�-------------Size---_ --J'�1� S-----Liquid depth---'Sl- --I- -------.Capacity.offild '/J---/- Disposal Field: Distance from nearest well----I`AP-1.-Distance from foundation---- -9.........Distance to nearest lot line---lgq_r--- {'� �pVey Number of linen-------/----- -----------------Length of each line__.-�d------------ ---Width of trench_-. `r.----- Type of filter mate ria l._--.- - ._.----Depth of filter material------_1__--____ ---Total length f_- a_--------,•--------------------- Nil Seepage Pit: Distance to nearest well----------------------Distance from foundation_________-_.___.__,Distance to nearest loft line----------------- ❑ Number of pits - Lining material------------------- --- Size: Diameterf----------- ---------Depfh----------------------- Cesspool: Distance from nearest well ----------------Distance from foundation------------ ---- . Lining material--_-----------------_-_--- ❑ Size: Diameter- y {;--� --.De,oth----- --- -------------- ----- ;--Liquid Capacity ""Privy: Distance from nearest well----------- ------------------ -------------Distance from nearest building_---_------_------- ❑ Distance to nearest lot line Remodelingand or repairing } � c.� ,•a-�,� - - - - �------- ------ ----- , ? -------� --- • „ ----- s sac. --- -- S^ Gfl7, ; �� ►� y�Q�' ,/ !. �y1 Yom/_crf 'f f�;-------1)% t�crlFrx/t� -Y ----. = " iG5Oe-c._tif--� -- d ------------------------- ---------------------------------------------- I hereby certifyfhat I have prerpared this application and that the work will be done in accordance with San Joaquin County ordinances, State lays ,and rules and regulations of the San Joaquin Local Health District.' Contractor] (Signed) -f!V ; ` [Owner and/or 8y:. -------- ------ ------------------------- ----- - .�. Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be .placed on reverse side). I FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED B ,a - .> REVIEWED BY - ---------------------- -------------- DATE-- ---)/�`e x: ---- ------------ -- DATE BUILDING PERMIT ISSUED-------- -- ---! --- ---------------•------- --- -_--- ----- DATE Alterations and/or recommendations:---------------------------- _ u. ' --- -- ------------ ----- - _____---------------------------_---------------________i__ --------.------------- ..............--__.-___----_-_-____-_-49__-_--__-_._-_----._______---.--------.---------..---------------- --- ------------.--------- _ ____________ __________ -----------------___________ ____ _________------__________ _ _____--------------_--------------------____......._-------_--------------------------------.-----------------_-.----------------------- + - ----------------------------- ---------- FINAL INSPECTION BY - ` Date. SAN JOAQUIN LOCAL HEALTH.:DISTRICT J -A 4 Q, 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street � Stockton,California Lodi, California Manteca,California Tracy,California ; E.N.9 2M 1-67 Vanguard Press r fit