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FOR OFFICE USE: t --------------------------------------------------------- -------------------------------- ------ --------- APPLICATION FOR SANITATION PERMIT Permit No. _.__-_ .. ---------�.`� ---------------------------------------------------. (Complete in Duplicate) - _FDate Issued _�a___Z�.-_6_ ------------------_.---_-_----- :----------- --------- 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 with County Ordinance No. 549. F JOB ADDRESS AND LOCATION------ Q ... Ja_Ck__'P-ons--- RQAa=---------------------------------------------------- -•----------------------------•--------------- Owner's Name----- •--10arl -----•---------------------------------------------------------------------------------------- Phone ------------------------------------ Address-------------------------------1305-5--- ��--J---------------------------------------•----------------------------------•----------------.--------------- ' Contractor's Name ----------- G_u_aZ Iat.e_e_d__H=05------- 44 -1/__`------- Phone...-• Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms ---- Number of baths __2.___ Lot size.--__________________________________________-___________-_ Water Supply: Public; system ❑ Community system ❑ private [X Depth to Water Table___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (If yes,clate-r -: _ --._) No ® ,New Construction: Yes [N No ❑ FHA/VA: Yes ❑ No ❑X TYPE OF INSTALLATION AND SPECIFICATIONS: 4 F (No septic.tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well --- 200_1--- Distance from foundation__-�_n__'______.Material_-_--4Y _______ ._ __ _ ----- El No. of compartments ---------- 2 ------------- SizJn_7^!t 6`_'f_.tiquid depth---__-1---------------Capacity.3_500--gR1. \ disposal Field: Distance from nearest well. ---- 150.1._ Distance from foundation --____I_ 't___ -Distance to nearest lot line -3A., ------- r $] Number of lines ----- r2- --------- --------=--------- Length of each line ......... x,00 s___------ Width of trench ----------2 1------------_----_-- � Type of filter material ---- lwr.1:--- V1.GZepth of filter material ---------------------- Total length ------------------------------------------ Seepage Pit: Distance to nearest well_____ 101_ -_--Distance,,, ,fro_m` foundation -------------------- Distance to nearest lot linelb_______-_ Number of pits---2----------------Lining material__lt----------Size: Diameter ----sal-__ ------- ---- Depth ----- 25.1 --------- .---- ----. t' 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------------------------------------------------------------------------------------------------------------- -- ------------- --- ----------- Remodelingand/or repairing (describe): --------- --------------------------- --------------------------------------------------- ---------------------------=------------------------------- -----------------------------------------------------------------------------------------------------------•-----------------•------------------------------------------------- --------------------------------------- --------------------- -------------------------------------- - - -- - - - - -------------------------------------------------------- I ---------------------------------------------------------------------------------------------------- ----------------------------- I -- -- ---------------------=--------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared 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)----- C -a- -- Yf C S_ ar�i_ 1 .Cii7 f- -I �.------'---------------------------------------------------------- (Owner and/or Contractor _ - - �//��' 6r ---------------------- v-----=-`"" (Title) .._P _side _ .. _ _ {O d f a C for it I'g_ - (Plot plan, showing size of la , location o stem in relation to wells, buildings, etc., can be placed an reverse side. FOR DEPARTMENT USE ONLY t' . APPLICATION ACCEPTED BY DATE --_'V_ -J -6-P------- --------------------- REVIEWEDBY ---------------------------------------------------------------------------------------------------------------------- ------- DATE ------------------------------------------ ----------------- BUILDINGPERMIT ISSUED ----------------- -------------------------------------------- •--------------------------------------- DATE --------------------------------------------------------------- Alterationsand/or recommendations:--------------------•-----------------------------•---------------------------- -------------------------•-------------------------------------------------- ----------------------------------------------------------------- - --- ------------------------------- -_1 ------------ L --------------------------------------------------------------------------------------------------------•------------------------ ------------------------=---------------------------------------------------- - ---------------------------------------------•----------------------,---------------------------------------------------------------------------------------------- -------------------- - ---- --. FINAL INSPECTION BY ------- -- Date-- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 West oak Street r '' 124 Sycamore Street 205 West 9th Street Stockton, California •nodi, California n �'� Manteca, California Tracy, California i }. ES 9 REVISED B-59 2M 3-'63 i -P-00.