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FOR OFFICE USE: 0 ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _11f ----- - ------------------------------------------------- (complete in Duplicate) S, ----------------------------------- ------ ------- This Permit Expires 1 Year From Date Issued Date Issued .. .. ....... A*Ile Application tion 'is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. County Ordinance No. 549. 0 a-T_ Tkis,��p lication is made in compliance with r 40 , j ------------- �CA 7 __Z�------ ----------------- ------ ---------------------- 'JOB Z15WSS A 4V_/ -1 --- ----- --------- ND LOCATION 1- 4- ------- Phone.----------------------------------- - -_110 1 --- ------I-------- ------- ------- Z�------------------- - ------- ---------- Owner's Name------ -,e---------V-.6�_ -, _ ----------------------------- ---------------------------------------- Address------------------------ 4.- ----------------------------- - Ph ----------------------------------- i --------------------------- ---- one Contractor's Name-------• 4��----- --------------------------------- T M Installation will serve: Residence J2 Apartment House [I Commercial [3 Trailer Court El otel El Other 0 I 4�40 -------------- Number of living units: _L-____ Nurber of bedrooms'.3---- Number of baths -i Lot size Water Supply: Public system [] Community system E14 Private X Depth to Water Table 1-a ft. Character of soil to a depth of 3 feet: Sand F) Gravel 17`1 Sandy Loam El Clay Loam C Clay El Adobe [] Hardpan ] Previous Application Made: (if yes,date--------------- No New Construction: Yes ,[4 No E] FHA/VA.. Yes Ej No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -i;l-- hin 7200f-feet.) '(No septi t is iiv 'I it c an or cesspool perm ed if public sewer aia ew Septic Tank; Distance from nearest well__rA--------Distw from foundation____-----9--------.Material_ No. of compartments-------A-_-------------S i z-,e---------�1_7__S---- ---Liquid depth--.---.O7----------------Capacify__/_49�------- ! Disposal Field: Distance from nearest A'11--j- A-Distance from foundation---Zb-----------Distance to nearest lot line--I--------- Number of lines-----,;?"--------- Lehgfh of each line----/&-02---------------Width of trench_-___. ------------------ V142, D' fin �- __._________________________ Seepage of filter materia ep of filter material------/_9 9_______-__.Total length__-,�n Distance to nearest weT/--------------Distance from foundation----LA.........Distance to nearest lot line-r----------- Seepage Pit: Number of pits----R-r-------------Lining material ------Size: Diameter---;�-3."_------Depth--- ------------------ fl Cesspool: Distance from nearest well-----------------Distance from foundaf'ion--------------------1ining material__._-----__-_.-__-__---_-___________ 0 Size: Diameter------------------------------------ Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: ------------gals...r- Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building-__.._____-_-_______-_______- -- 171 Distance to nearest ]of line---------------------------- ----------------- ---------------- --------------------------------------------------------------i Remodeling and/or repairing idescribe)- ------------- --------------- ---------------------------------------------------------------------------------------------------------------------I- -_ --------------------I-------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------- ---------- ------------------------------------------------------------------------------ ------------------------------- ------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance, rule and regulations of the San Joaquin Local Health District. _M1 a laws, rul ---------------------(Owner and/or Contractor) -- -- - - -------------------------- --------------------- ------------------------------------ ----------- (Signed)--- --------------- - ' e u'e an C, '19 Ua,'L..2' u' - -- ------------- r -BT.�7-7 ----------------------------------------- —------------------------------------------------ ---------------- I----------------- 0; o . etc., can be placed on reverse side). (Plot plan, showing size of lot, location system in relation to Wells, buildings, i, 0 i_ FOR DEPARTMENT USE ONLY Y .. ........... ---- DATE----- -------------- APPLICATION ACCEPTED BY------ ---- -- -- ----------------------------------------- X----------------------------- REVIEWEDBY-------- ----- - ------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------•----------------- ------------------------------------- - DATE. --- --------------------- --------------------------------- Alterationsand/or recommendations:------------------ ------------------ - ---------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------- -------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- -------------------------- -------------------•--------- ---- ------------------------------*----------- ------------------------------- ------------------------------------ ------------------------------ ------------- ----------------------------- ------- --------- ------- -------- ---------------------------------------- --------------- ------------- ----------------------------------------------------- ------------- ------------------------------- ------ FINAL INSPECTION BY:__-;� __1_ �__;1,15_�_ --------------------------- Date_---- J ------------------------ ---------------------- -01 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 ES 9 REVISED B-59 3M 3-*63 F,P,C[3.