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I FOR OFFICE USE: ------------ r 1 �� ..-- -----,,---------------------_--------_-------_--- APPLICATION FOR SANITATION PERMIT Permit No. ___....... ........ ------------.----------------------- -"2'- (Complete in Duplicate), . `Da"te'Issued 1___7/-30_43 --------------------------------------__-----'___.__._._._ This Permit Expires I Year From 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 Count Ordinance o. 549. " 3 ----- -- ----------- --------•--------------------------------------------------------------------------------------------------- JOB ADDRESS AND LOCATION- _ Owner's Name---------- --- - - ---------------- Lr-`-"---- Phone------------------------------------ 7 ----•--------------- ••---- i . .. - Address---� _...... ----------- Contractor's Name- --------------------- .----- ---------------------------------•---------------------------------------------•---------- Phone----------------------------------- Installation will serve: Residence ET y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms_._ Number of baths __,i!.__. Lot size _Xg1Lj --------- -_'��_..��__ { Water Supply: Public system 2-6mmunity system ❑ Private ❑ Depth to Water Table !y_--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam`❑: Clay Loam ❑ lay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date------.-------------) .No New Construction: .Yes No ❑ -FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ! n (No septic tank.or cesspool permitted if public sewer is availa6le.'within`200 feet.) �' } Septic Tank: Distance from nearest well___-_•--r-_.----:Distance from foundation--4___________.Matenai No. of compartments___2_.—--------------Size_J -------Liquid depth_4_-_.1___-- Ca acit Disposal Field: Distance from nearest well_----_____-Distance from foundation_I1J----------------Distance to.nearest lot line________-_______ [� Number of lines-------- Length cf each line------Z5------------------Width of trench-- .-��--------------------- -------- ,Type of filter material - 4G ------Depth,of_filter.matenal_J8y__--------------Total length-__._A ------------------------------- See t �—/ Seepage P Distance to nearest well_._` ----------Distance from foundation------1___ ____.Distance to nearest lot line---------- -----� Number of pits___.-_ `�cz________Lining matersal_-�t�_�.�.Size:rDiameter_____�._�___�-�__-�pepth_ �_.�___________._._t ; Cesspool: Distance from nearest well_ _______________Distance from foundation..__._'.. material--------------c----_-__-_-.________ ❑ Size: Diameter--------------------------------------- Depth------------------------------ „-:-------------kqi -,Uid Capacity-----_----- --------------gals. ' 'Priv Distance from nes est well---------------- - ._Distance :from nearest buiidin' t y• r � , ❑ Distance to nearest lot line------------------------------- - Remodeling and/or repairing (describe)--------------------------------------------------------------------------.......----------------------------------------------------------------------- --------------- F. �. f ------- ------------------------------------ ----------------------------------------____•_- ___________________I r_________-_________-______________________.________-_________---_-___,--------------------------------------- I --________.__-_____.___..________._._I hereby certify that I have prepared this a licat' in and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and Fr'egulatio of a San J aquin Local Health District. ` k ---------------------------------------- (Signed) • ----------------------_(Owner a nd or Contractor By:------------ Plot Ian, showin size of lot, location of system in relation- ------- „ Y_________r---------------------------(Title)---------- ------.---------------,-._.__---.-- -. _ ---__._..__ ( p showing.size y to wells, buildings, etc., can be placed on reverse sideP FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �_ °------------1---------------------------------- - DATE ? a~ ” REVIEWED BY----------------------------------- -------- -- �------------------------------.:"�_':' " —DATE_---=__' __ µ BUILDING PERMIT ISSUED --------------------------------------- DATE-------------------------------------------------- - -- Alterations and/or recommendations: - 0 ----------------------------------------------F - ----}•- Y- - -------------------- ------ ------------- �_-: `� 1 *� -.3 --- — �rrs:P'1�• ._,!+:� -r--`•-- ------ ----------•--•------------ ----------"---- r ----- ------------ FINAL INSPECTION BY: '. - - `------------------------------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California 99 9 REVISED a-59 3M 3-'63 F,P.CD.