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FOR OFFICE USE: --------------- ------------------------------------•---- ��j7 p ----- -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.69 .../..._`� ------------ -------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San 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. 549. 0A4 Lp14 ro'?-e -s • K 44ed&,6 JOB ADDRESS AND L CATION-- ._/41"IF-E - 461A �- -�F_. ......•-----------•-- r �e �y� OwnersName__.._ -. .. ----------------- -----------kl----------------------.--------------•-------•-----•------------------,Phone-_03......---...... •---- Address C7L�C°-y4-h ----- . --!4_r(_� .�?f`'.!!t t Contractor's Name._O-A) .._.�4_[,_ -- - � � � -- - - -- -- -�-- -�-�-�-- -�F'�.� i4�-� Phone-�.`1�._��--.=-�-�- --•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __#_____ Number of bedrooms .5._ Number of be 3 +" __--_-_---- �. Lot size .---f----------..�-----�-•------------- Water Supply: Public system ❑ Community system ❑ Private (� Depth To Water Table 7b_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam &T Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date.____._____.__..._._I No 0—New Construction: Yes ❑ No� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well_'...........::.Distance from foundation--------------------Material______-.__-.:_.___.__.______-.-...__....___..__. ❑ No. of compartments--------------------------Size-------------------------••-----Liquid depth---------------- ---- ----Capacity---------------•---•--- Disp_osal Field: Distance from nearest well-1-0-0...Distance from foundation_3�_F�..Pistance to nearest lotrline Q. '�fl .Number of lines.__.,_��____._..__-_ Length of each line 4 34-_fl3b.Width of trench.3.34" .. _. Type of filter material-_-_ _, __ 64�Depth of filter material-----/--�'...___..__Total length___ `~ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line.......-......... ❑ Number of pits-------------r-..-----Lining material--.--------------------Size: Diameter---------------------- Depth------------------_.--------_---- "; I 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/ r,repairing (describe :___ (1--� _____ __ ___________•--___•_��$a.vL -{ ------------------------------------------------..................................---------•-•---------------------------------------------------------------- ------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, d rules and regulations of the Joaquin Local Health District. (Signed) Geed f or.Contractor) BY� =. = _;---------------------- -- Title ----------------------- ------------- ( ) (Plot plan, showing size of lot, loco+i f system in relation +o wells, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-�s-- Q--t---- ------ ---------------------------------------------------------- DATE------- / _�_ �oo -- ---------------------------- REVIEWEDBY--------------------------------- --------'------------------------------------- ------------ •--------------------------- DATE----------------•--•---------------------------------------- BUILDINGPERMIT ISSUED--------- -------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------..._..-•-•------•--------------------- --------------------- -- ---..... .................. •------ ----------------------------------------------------------- I 'FINAL INSPECTION BY. ...... S Date y7j - .�/ -' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California E5'9 REVISED 8-59 214 9-52 ATLAS