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rUK (_)"K_t Uat: APftATION FOR SANITATION PERM1140I Permit No. - ----------- ---- -......0 ..- (Complete in Duplicate) Date Issued % p This Permit Expires 1 Year From Date Issued G Application is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDCATION:r.�-- 'f - Lat�rA ✓`.t , -----=........._-.............................. - Owner's Name... ------------ ------- .. .. Phone----'------ --- - Address-----"'------ -------- -------- -- ----- ------ ..... ..... ------------ ---" ---------------------------------------- ' Contractor's Name......... .......... �_------ sl_- --- --moi.¢.,_...>ae-......... - -.._---....----'-------- Phone------'----------- ---'---------- Installation will serve: Residence 250�Apartrhent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other q Number of living units: ..... Number of bedrooms .. Number of aths .<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 ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---- ---------- ----) 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.) Septic ank: Distance from nearest welLc ?,'..01_-.Distance frong found tion__.LU._._----Material---------- �Kv-�--.............. . No. of compartments..._....._7-:.__._r_Size �r.� Liquid depth__r..... ...............Capacity__L: Dispos Field: Distance from nearest well-mc ft-----Distance from foundation....--(.:_.__..___.Distance to nearest lot line.cS'.... .... Number of lines........ .S--�--s __..._.__._Length of each line___1_C.Z ..________..Width of trench.__�r ._,�_-..........._. Type of filter material.___._1..�._J___Depth 'of filter material-----/4. .......Total length-__ -_----............. See pa Pit: Distance to nearest well .__ /�0---._Distance f�m oundation..-../.C..-_.Distance to nearest lot line__ ._._ Number of pits. ' ._. Lining material..._.. r_.._-Size: Diameter. .. .✓?-3...._-Depth_,--",*A Cesspool: Distance from nearest well.._._._.1.....Distance from foundation-----.--------------Lining material--------------------....__._.._.. ❑ Size: Diameter---------------------t---------1-----Depth....---------------------------------------- Liquid Capacity------------------------_-gals. Privy: Distance from nearest well...........I-----------------------------------Distance from nearest building----------__..___.____.___..._.._----- ❑ Distance to nearest lot line----------'-------------------------------------------------------------------____--------->----------------_----------------- Remodeling and/or repairing (describe):------ .---'-------------------------------..--+---------------`-------------......-----'-----------------............-------------`-...... ...... -------'---------------------------_-------------------'------------------------------------'------------------'-----------------------------------------................---------------- L -------------------`------------------- I hereby certify ----'----'---------'`......-------- ------- -- -- ---------------'-------------- " - that I have prepared this application`and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. .�--- --------- ---- --- --------- -,/------------ -------------- - - .._ --------------------------. oe�md/or Contractor) (Signed)------- ;/�/ By: CA- `mac'' -'--"`..+-------' s-ir - -----(Tidal------------ - - - - --' - -'------ (Plot plan, showing size of lot, location of system in r ation to wells, budWings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.----- ' / --' ------------------------------------------------ DATE--'--,/1..__r.1--,?----- ------------------ REVIEWED ---------------REVIEWED BY-----------------------------------------------._---------------- -------------------------------------------------------- DATE-------------_---------------------•-----------"- BUILDINGPERMIT ISSUED------...............---------------------------------------___................................. DATE------ --------------------------------------------- Alterationsand/or recommendations:----...----------------------------------------------------------------•--------------------------------------------------------------------------- ------------------------ -------- ---- ----------- -------------------------------------...---------------------- .........-----'--.........----------................................................ ------------------------------------ .............. -------------------------------------------------------- ----------------------................................--------------------------------------- - ---------.......................--------_---------------------------------------------------------------------------------------------- -------------- ----------------------------------------- FINAL INSPECTION -< �� / f------------ Date.._- ------------- =( --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxa Iron Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca, California Tracy,California CS 9 REVISED 0-59 3M 3-'63 F.P.CC.