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FOR OFFICE USE: -------------------- -- ---------------------------- C� -------------------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../. /_._. ----------- - ----------------------------------- - (Complete in Duplicate) � ---------------------------------------------------- --- This Permit Expires 1?Year From Date Issued Date Issued --------��--- - y Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein described. This application.is.made in compliance with County Ordinance-No. 549. 8/;�/, � /y/�ar2j�,Cjy/• 7�I�gy JOB ADDRESS AND LOCATION__--9-------��/ �a• ra a� 7�5�: 2T �"/,� 'L►�- ----------••--•---- ----------I�-------------- Owner's Name------ - - -- - - - --_ Phone s ..---••-- r1 /tel---------- Address �� ;^ --------------•---------- ------------------------------------------------ + Contractor's Name ,/ ------ --------•-----•------- --------- •-------- Phone4W—,94127 Installation will serve: Residence R Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- ----- Number of bedrooms ___Z Number of baths ----- Lot size ------/-C 's____________________ __ Water Supply: Public system ❑ Community systemEl. Private`,Nr Depth to Water Table 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 IN -HA/VA: Yes ❑ NoK TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ,14 Distance from nearest well-----------------Distance from foundation--------------------Material ____---; ElLiqNo. of compartments Size :_----------------------- uid depth---------------------------Capacity-:.----------------•-= ((� Disposal Field: Distance from nearest well-.-f Qui_._Distance from foundation----VP........Distance to nearest lot line__._:e'�-C� Number of lines-------------__ _------------------Length of each fine____ rL?_-_ Width ofdtrench-------- Type.of filter material___19__.____C------Depth of filter material___-- IR- ______Total len th,ti------------- a Seepag j,r Distance to nearestwell___,1iL _ -------- from foundration-___-�> _ _.__.Distance to nearest lot iine----- � Number of pits_--------I-----------Lining material__Z_00_K-)--Size:�Diameter_----------Wl!-:-----Dep ------------- ---�.�5_.---,--__---- i Cesspool: Distance from nearest well-----------------Distance from foundation.'_'__-' _.__._..Lining.material_�::i_ ____________________- ❑ Size: Diameter------- --------------- - -Depth--------------- -- ► _ -._Liquid Capacity gals a Y ___.____.Distance from nearesf,buildin.g__.__ Privy: Distance from nearest,well.-- - - __w.. 4, ❑ Distance to nearestlot line _: ---------------------------- ------------------------ ----- ) 1 Remodeling and/or repairing (describe): t ,.� a•C.__ -- s Vim_, ;--------•--------------------• i 4�.. ,,� ;i) ... -`_ 2 = s r _ I ----- ------------------- ----------------------------------- ----------- ------a ---------`-----•---------------------- `---------- --- -- l - I l '# F `.` ----------------------•-•----------.-->.- ----•--•---------------------------------------- I hereby certify that I have prepaeed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.. (Signed]______ i4 s�,PC r ___-(O tier and/or Contractor) ------------'-_- _ -- __'-- --__-- - _---------------- ------------------------------------------------ _"__-- �_BY: [ 7+✓..._-- -�11%_ ------------ - •---------------------I----------- ------{Title)-- (Plot plan, showing size of lot, location Of-s em;in,relation to wells_buildings, etc;, can be`placed on reverse side). { —..FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY____ _-!!L=t--- . ..-- -`-----------------------_ -_---} - DATE------Z - ---------- REVIEWEDBY--------------------- --------------I------- ----•--- --------------------------- ------------------------------- DATE - ------------------ BUILDINGPERMIT ISSUED--------------I--------•-- ---------------------------------------------------------- --- L- DATE---- --------------------------------------- Alterations and/or recommend ianss = `�-- -__� - -.._ "_'-�_ _.--------- �� / -� ---------------------------------- /`"L- � i:- _q � ." � = -----------• ---- -- - -----•-•--------------------------------------------- ----------------------------------------- -------------------------------------------•---------------------------------------- ------•---------- - - --------- ------------------------------------ C FINAL INSPECTION BY-------- --- ----------4-- ------------------------------------ f Date------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-•63 F.P.Cq. —