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FOR OFFICE USE: ----------------- ----------------- ---- ------- ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..� 1 IM- _ (Complete Duplicate) �� ': Date Issued ...--._.-_._---------------------------- This Permit Expires I Year From Date Issued Ap'p'lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This fapplication is made in compliance with County Ordinance No. 549. -^7"�L• J06,-ADDRESS A ,-LOCATION-,�- +- Owne,r'sName---- - " --------------------••---------------- -- --------------------------------------- -------- ! , G --------------------------------------------------------- Phone---------------------= Address-'--------=- --------lq--- •-- �-A: ----/9--------•---------- ------- - ----- --------------------------------------- -- ------- - --•-- ---- a : i / /�. Y , Contractor`s Name--- ------ -- ----------OJ �L ----------- --------------------- Phone..----------•-----•-----.- .------- Installation will serve: Residsnce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ IMC Number of living units:._---- Number of bedrooms - 3 Number o baths ±___,_ Lot size _____..___._ s 4 Water Supply: Public system ❑ Community system ❑ Private Number t Water Table i Chharracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Prevlous!Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE. OF INSTALLATION AND SPECIFICATIONS: �, E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance f � } rom nearest well_________________Distance from foundation____..__.__________.Material______�.____.._____..._.,_.__________.____-.-_. No. of compartments--------------------------Size-------------------�-?------Liquid depth.----------------------. Capacity`--------------------- Di'spA Number o e, ' f - _ /� � 4 rom nearest well.____.-��..._._._._Distance from foundation=..}._.._________.Distance to nearest lot {ine___.___.-_-_____ os field: Distance ff lines_________ ____ __ _.._- ___.._Length of each line- -_-�-�_f'�-,_--..-Width of trench----�__��^.._.._-______-._. T e of filter h 1 " ------- yp llter material.__0�_ f_Depth of filter material._-.__� .__!_�Toltal length__ ____ ° --_-------_ Seepa Pit: Distance to nearest well----Ze�----,_Distance from oundation_____/_42______.Distance to nearest lot line_____- ' -� 4f its------ _ Linin material ---�---Size: Diameter �.r� De th---,2.�-�------------ Cess ool: D stcb Ce al p ,�-..__-.._. g _ p Spool-. inng material ---------=------------------ from nearest well_________________Distance from foundation_____-_-�_.___._L' ❑ Size: Diameter------------------------------------ Depth-------------------------------------�----------Liquid Capacity----•-----="----------...gals. -Distance from nearest.buildin -' --------------------- I.! _____________________ z Priv Distance.from nearest well---------------------------------------------_.___..______.____--____ r g_ ---. __ I.!❑ Distance to nearest lot line-------------------------------------------------------N-fA........I--------iti-------------- I - ,I, . , i =--------------- Remodeii and/or re airin describe :__.___. .. ----- -^ --_ --- n9 P 9.:1 ) ------------- I 5 --- I' �I --------------- -----------------------------------------------------------[t; -- { 1 � l hereby c that I have prepared this application and that the work will be done in ceordance iA San..loaquin County. ordinances, St to la , and rules and re ula+io _ e San Joaquin Local Health Di-. � t:: {Signf .-- I-------- --------------- - - .. Contractor ed)--�---- -------- �`�--=-------------------�- --..�'` -"- -------� ,'"°�and ) plan,Y '�1•'L ! ------------t 13 =----- ------------- ---- -------------- --------------• - -- -- --`-��'--- -- - -------------------•--{Title) --- - -- - ---- �--- --- (Plot showing size of lot,' location of system in relation to webuildings,etc,,.can.be placed on reverse side)._ s ,. � FOR DEPARTMENT USE ONLY s ; ...______••_•__________ _- _____•____• APPLICATION ACCEPTED BY----------. -- ------------------------------------------- -- DATE:--------------------- ------------------------------------- REVIEWED BY------------------------------- ------------- �- . � BUILDING PERMIT ISSUED � ------------------ DATE_- Z � -------- - -- ---- attn ---- '- Alteratons and/or recommenVVVVV ._.. 1. -----•--------------------------------------------------------------------•__--_._-__._--------_-_------.P---J----1 --- _=-. -------------"---------- --------- --------------- .11 ------------------------------------- -------•------ •----------------------------- -'----------=----------- "-------- --------=-----'------------------------------------- ------------ ----------------------- ------------ ----------. ------------ ---=----- ----------------- -------------------------------------------------------------- -------4 --------------- — - = E' - -'---------- FINAL fNSPECTION BYY-� � _» �" t Dater, Z'o ?. ------------------ -- Q �., ' � r - •-- .. i SAN JOAQUIN-LOCAL HEALTH DISTRICT----- 160 1-E. ISTRICT-----1601-E.Hatelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California B ES 9 REVISED 8-59 3M 3-'63 F.p.CC- �I f