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J-�CRFFICE USE:`--------"---------------- ----d-� 3 �1--_ - .-__..__-__-__-- APPLICATION FOR SANITATION PERMIT Permit No. __Z......_....Y.._._. ------------------------------------------------------ (Complete in Duplicate) Date Issued - -G 2– ----------------------- -------------------_-___-_.-_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perm) ,to con trust and install the work herein described. This application is made in compliance with County Ordin _; 5 j°a " t / JOB ADDRESS AVNOC TION --- - ----- -- Owner's Name-__ ' _ -----------------• Phone--------------------_-............ ----------------------------------------------------------------------------------•-------------------Address.-- = Contractor's Name______________--------------------- Installation will serve: Residence [gr�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 9 Number of living units: _Z._ Number of bedrooms _ 2--- Number of baths _f... Lot size ___��X`��............................... Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table 40Q4. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (if yes,date--------------------I No (I?"O'New Construction: Yes (?'no ❑ FHA/VA: Yes W?'0^N"0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----—____Distance from foundations_ �_.------.Materal____&-e,A; `.___.... ®� No. of compartments_____ _ ______ _ //�� "-Liquid depth - ___Ca Capacity ick q P P tY Disposal Field: Distance from nearest well-_-` '"'-._Distance from foundation--/10----______Distance to nearest lot line.r. ........... 9?0_� Number of lines------- _____-_ ___ _Length of each line___ O�_ Width of trench__•��___. .11 Type of filter material p �� g _ _ __De Depth of filter materlal._��_._____._.__Total len th_____�f�........................... Seepage Pi Distance to nearest well--___- -:_Distance f om fo dation___.. .......Dist nce to nearest lot line_��--- _ Number of pits---,�_______________Lining material. . -Size: Diameter__&9__ --------Depth-_A_46_-_�___----_________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_-_-___---__---_____---______________ . ❑ Size: Diameter Depth ---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________________.___.___.________-_. ❑ Distance to nearest lot line --------------------------- -------- -•----•------- -------------------------- -- -- Remodeling and/or repairing (describe):1---------------- T -•----. ------------------------------------------------- ------------------------•--------•---- ----------------•---------- --------- - ' -- �_ z✓ ------ H-Vyce--,..,, - t = ------------------------------------------------------- I hereyth{at I have preparethis�application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and gulations of th San Joaquin Local Health District. (Si ned 9 )........................... . .._.....-. .. - ---- ----------------- - -------------------------- -------- r Contract By:....................................................... ------ ••---- - --------- -----(Title)---- ........................ (Plot plan, showing size. of lot, location of system in re n to wells, buildings,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ,_, --� =��— '', ------------ -`------------------ DATE-----f ��1------ REVIEWED BY----------------------------------------- ---------------------------------------------------- DATE-------•------------•-•------------------------•---••--•--•- i BUILDING PERMIT ISSUED ----------------------------------------------------------------------------- DATE--------------------------------------------- Alterations --•------••-------------------------Alterations and/gr recommencrations: -------------- ..... ........ .. .. ....... _-------------------. -................... .--._ l - FINAL INSPECTION BY:-... --------------------•----- Date-----s -� 7--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street: .��.,, V'` ,i 24 Sy amore Street ` 205 West 9th Street Stockton,California lodl,California Mantua,California Tracy,California ES 9 REVISEO 8.59 2M S-61 ATLAS