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LL FOR OFFICE USE: - � ----------- SPS i APPLICATION FOR SANITATION PERMIT Permit No. ..... ........... ------ ---------------------------------------- -------- (Complete in Duplicate) C, S ----------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _______ Application is hereby made to the San Joaquin Local Healfh District fora permit to construct and instail the work herein described. This application is made in compliance with County Ordinance No. 549. t _ JOB ADDRESS AND LOCATION /---------:71�;1�4�0------------- ---C l -- ------ ------------------------------------------ Owner's Name------------Z---------r -----------Z--f- --- ------------------------------------------- Phone_. Address - 1 ' P-T ---------------------•------------------------ Contractor's Name--------- ----- ----------------------------------- Ile Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/--.. Number of bedrooms - .. Number of baths -;kLot size ........... � .BGG ----------------------- Water Supply: Public system ❑ Community system ❑ Private I- Depth to Water Table :?9- ft. Character of soil to a depth of 3 fee+: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam (-"Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_---- -. ) No New Construction: Yes E] No �HA/VA: Yes ❑ No [� + 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 foundation-------------------Material-._--.--- -------------------------- - --------- ❑ No. of compartrr'tents-=------------------------Size--------------------------------Liquid dept--- ------- -- Capacity M Disposal Field: Distance from nearest well_.EVt2..=P-.Distance from foundation---_7e2---------Distance to nearest lo} line_._.:_.__.._ Lg� Number of lines_____ __ _____ _______/_ ___ ___-Length of each line---- of trench.__a.--------------.._---__--_ Type of filter material- / c2' .--Depth of filter material-_--f�_---__ __-_Total length-__._—c— ----------------------- r i ♦ - 0 f Seepag If: Distance to nearest well_ ___ Distance fro foundation ? 00 ______.Distddan�c�a to nearest lot line-�4240"_..' O Lining material___ _,�1�`. size: Diameter_._ _.1--- �' Number of pits----------f---- - - - Dep#h ,� 0 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----- - --------------------- - ----------------------- -----------------------------•------------------------- ------------- a- t p l -l/ i9/ Remodeling and/or repairing (describe): ��--------�X-h`5--7-71/1 --- p! r -------------------- -------------------------------- ------------- ------- -- - ---------------- ----------------- ------ --------------------------- ------ p I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State lawses and regulations of the San Joaquin Local Health District. 404 (Signed)--------------------- ------------ f �l----.--- ----- .s . ----------------------------------------------------------- -------. r nd/or Contractor) ---------- - -------------(Title ----- -By--------------- ---------- (Plot plan, showing size of lot, locatien p4 system in relation to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY / _---.------ DATE._.__53"__ _. �� _-- ` ------ REVIEWEDBY ,.. 't ------ DATE-------- ---------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------- ------------------------------ - i DATE-------' Alterations and/or recommendations: .3p__rSs___1iCca._ - -- - �------- �r ---- ---------- ------------ --_x_.-:__-_-----_------------------------• ----------------- --------------------- ------------------------ --------------------------- FINAL INSPECTION BY:._. --- G �`-- Date..... p G .. 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 r F.P.CC.' r