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FOR OFFICE USE: ---- - - - --------------------- ----- ---- - } APPLICATION FOR SANITATION PERMIT Permit No. _!_..�-•-�P• ------------------- -- ------------- , -------------- ------------------------------------- (Complete in Duplicate) Date Issued __--X/3_/45 -_--- ----------------_-------------._.--. This Permit Expires 1 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 ith County Ordinance No. 549. P I T'o iAl Si DE ' _____J ------ ----14wY ... _4_-____. JOB ADDRESS AND OC�ATI1ON____.- __ KT ---------- ---jg---------.�"--- !l1--. 777---is- / Owner's Name.----------Him- H F--•------C7_� �_ �- --- ---- --- - -------------- -------- Phone ��. Q• ' y .• --------- -1.:��------------------•--- ---- ---------------------------------------- Contractor's Name__CAIKGij� - ---------------••---------- ----- ------------------- Contractor's Name--- A- - ----------- ---------------- - --- -- Phone_._- .--•-------_---•------------ lnstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --- Lot size __ C-5� _ = Number of living units: .f__ Number of bedrooms __�_L—___-_ Number of baths __� +� .I 104,-ft. Water Supply: Public system El Community system F1 � Private tepth to Water Table I Adobe Hardpan Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ 1�l d Previous Application Made: (If yes, ------- No New Construction: Yes ❑ No ®tel HA/VA; Yes ElNo it TYPE OF INSTALLATION AND SPECIFICATIONS: A _ - -(No-septic tank-or cesspool permitted if public sewer is available within 200 feet.)- ' k Y 1 Septic Tank: Distance from:,nearesfi well_________________Distance from faundation_____________.____.Material____.__-_._.___._______._.________----.---____. � I �1 l No. of compartments------ ------------------Size - Liquid depth Capacity k j-1--------- r Disposal Field: Distance from nearest wail----50__.-Distance from foundation___._ Distance to nearest lot ine____�______. .- .-- Length of each Zine-------- - --- - ._._.Width of trench_...-_-.rte .--- ----------------- t� 1 1 f�� Number of lines j ' Total length � Type of filter material__ 0--Cjk---Depth of filter materisl____._1_. `I ' Seepage it: Distance to nearest well______��_��____--Distance from foundation____ ____----_--Distance to nearest lot line----------------- V+ }` r 1 _._.____Linin material__-- Q�-:�' Size: Diameter.�_�- ___Depth___ a_------------ ------ Number of pits�___._._�--- g Cesspool: Distance f orri nearest well_- Distance from foundation- material----------------------------- Liquid Capacity_..._ els. ❑ Distance Diameter ---------- ------------------Depth----------- ---------- ----------- q p Y g 41< Size:Distance nearest well___________--------------------------------------Distance from nearest building.__._.______- ___.________--.____.____- Privy: ❑ Distance to nearest lot line............------------------- ----------------------------------------------- Remodeling and/or repairing (describe):-------------------------- ------------------------- ----------------------------------- �} ------------ ---------------------------------------------------- -------- ------------------------------------------------ I----------------------:i -------- --------------- ------ I hereby certify that I have prepared this application and the# the work will be done in accordance with San Joaquin County ordinances, State laws, and r les and regulations f, the Sa Joaquin Local Health District, r r/ �` � ---- -- ---------- ---------------------------(Owner and/or Contractor) (Signed)_ _ ! - _ ' ----------- ------------ ------------(Title)---------------------------------------- _ -------- --------- �(Plo# plan, showing size of lot, location of system in relation to weAs,buildings, etc., can be placed on reverse side]. . l :.I FOR DEPARTMENT USE ONLY —� �� ------------------------- APPLICATION ACCEPTED BY.......... �"�--`----- -------------------------------------- ------------------ DATE-------- REVIEWED BY---------------------- ----------- -------- ---- -------------- ------------------ ----- --------------------------------- DATE-------------- -------------------------------------------- BUILDINGPERMIT ISSUED-------- I----------------------- ------------------------------------------------ Alterations and/or recommendations* --- ------------ --------------- --------••---------- - ----- - I ----------- ---------------------------- ------------ ------------------------------------ --------------- --------------- ------------ ---------- . ------- ------ ----------------------------- --------------------------------------------- ------ --- --- ----------------------------------------------------------------------------------------------------------- FINAL INSPECTIZD ----------- - Date---------------- -------- -------------------------------------------- SAN.1 JOAQUIN ----------------------- SANJOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Haxellon Ave. 300 West Oak Street y Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca.