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FOR OFFICE USE: ` 7/9 9d� --- ------------- APPLICATION FOR SANITATION PERMIT Permit No. This Permit Expires 1 in Duplicate] - ---------- ----= Date Issued - - -- ------ ------------"-- "-- �-J Com IeteYear From Date Issued P _ Application is hereby made to the Sari 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. S49. JOB ADDRESS AN LOCATION ] Owner's Nam I -�I -`L- - -•- .- - - 8 ----------- ------ - -- ------- ------ Phone--------------------------------•- - ------------ - ---------------- - Address ;. —t-f-- -- --- ` -�" S ----- ----- = ; s F _ - Contractor s Name s-L� n �- - _.-. _�ez --.------•----- Phone.. --------- Installation will serve: Residence (( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ . Number of living units: ---/--.Number of bedrooms -4- Number f baths _ Lot size ___"_6. 2• : ----•---•----------- 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 dobe ❑ Hardpan ❑ e Previous Application Made: (If yes,date --------------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPEOFINSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic ank: Distance from nearest well ____Distance from foundation --p_._----_-Materiai...._____ __ _ __ __.___. f No. of compartmerits___"_ _""_"_�""""Size _� �1�: .�Liquid d�th___.__'jl_�.....___"__Capacity__ __ _ D_ ispos Field: Distance from nearest well_.'70------'.Distance from foundation---i GP--.__"""-".Distance to nearest lot line_'__.."-."_"""f��-- Length of each line--- of trench----�-/-------------------•-- - Number of lines______- _ - I, .Type of filter mat'na1___-s�_._____.�_Depth.of filter maters jI�_1,9.------ ----Total length_="_ _-_"__"""__`"""" S ` pa e Pit: Distance to nearest wall.___1_0-4..___Distance from foundation------- tt?-------Distance to nearest lot line_�.._____.__� O Number of _._"-_Lining material---- -=__._Size: Diameter-------- ._....__De th_ U Cesspool: _Distance from nearest welt-----------------Distance from foundation_._____._________.Lining material--------------------------------------- �" ❑ Size: Diameter - Depth----------------------------- -----------------------Liquid Capacity----------------------------gals, Privy Distance from nearest well-------------------------------------------------Dist'ance from nearest building.-.---.---_-------_---------------------. ❑ Distance to nearest lot line ---------------------------------_---------- ------------------------------- Remodeling and/or repairing (describe)------------------------- ------------------------•--------------------------------------------------------- ----- ----------------- P -�' ----"-----•----"---•--------------------------------------- ------------------- - ! r. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4- -.—,,ordinances, —.,ordinances, State I and rules and regulations of the San Joaquin Local Health District. - (Signed)---------------- f, ------ ----- ' . ---------- nd/or Contractor) 'P --------------------------------------------------------------- ----- - - By-------------- ---i---------- --- -- - - s�--�.- ---- --- ------------------------------(Title)------------------------------------- - ---� - (Plot plan, showi� size of.lot; location of,syste m relation wells, buildings,.etc.,.can be placed an reverse side). 'T ,y A9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- DATE----/-`12-- 1 -r REVlEWEQ BY ------'..'."'`, - ti= DATE = --------------------- BUiLDiNG s PERMIT iSSU=D - ---------------------------------------------------- DATE-------------------------------------------------•=--- +ions and/or remta+ions'Altern .. . -_------•-----•-------------- ----" --•------•----"----------------- t -----•---- ., }-------------------------- ----------------------------------------------------------- ------. -- . ------------------------------- ------------------------------------- ---------------.-_._- --------_-- _______._.______-_._._____"_-.__.__.____._---______.__ "-"_-__---._ _"____._. -___._____-.-_ .+ ` -k - _. . ______"___..___._______.__.__.. -.s-___.�____.__s_____ - e T. FINAL INSPECT-7C�N BY ��%�%"---�— -------------- Date----�.�- -�r----��---------------------------------------- F,. _ -- I SAN JOAQUIN LOCAL HEALTH DISTRICT --t-1 Hazelton-Ave: —300 West-Oak-Street... ,.,,.134"Sycamore.Street-- .x,._.,,,,.205-West-9th 1reet _ Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'53 F.P.CD. }