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FOR OFFICE SE: ------------------------- 4� +- -----------------------f'�" _ APPLICATION FOR SANITATION PERMIT Permit No. ....11_6___� ---------- ---- ------- ------- ------------- ------ (Complete in Duplicate) U fbate Issued -------; .27 I 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. 3; 1 JOB ADDRESS AND C TION r. ••----- ------------------------ I Owner's,Name- - � p 5/ —-----------------------------------------_'----------- Phone_--------=--------------_`---------- I Address ` -------------------- Contractor's Name---------------- -.-_�-- --- Phone } Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - - ___ Number of bedrooms --------------Number of baths -(_-_-. Lot size .r x--_,�_a ________ Wafer Supply: Public!system LJ Community system ❑ Private ❑ Depth to-Water Table 4.r-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] San Loam E] Clay Loam E] Clay E] Adobe-3�ardpan 11Previous Application Made: Ilf yes,date----..-_..,--.--.--) No New Construction: Yes ❑ No �HA/VA: Yes ❑ No Et— 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----------------- from foundation---_.---_-_----__-_Material-------a_--____-___.-.--_-_------.-----_--_--._. . fes - ❑ No. of compartments Size.... --------------------Liquid.depth------- ---- TCapacity----------------------- Disposal R Distance from nearest well.-_"—:---Distance from foundation,46 .._._.._.Distance to `earest lot li� YP %z�o_�# _Depthof filter materi - fi length_ y /` Number of lines----- --------------------Length of each line---- Width of trench � T e of filter material---f - �! ---------------f---------- 1 -------------Linin material,YoS-IC_:_____-Size: Diameter.-_-_ t Det P Seepage Distance to nearest well-_'r r J istance from foundation__,- � Distance to nearest lot 1i e-.,�_____ r Number of psts-, [ Lining ?-- .. I p h_i1>,Xr_ r -----J Cesspool: Distance-,from'nearest-well_--- --.--' Distance from foundation--------------------Lining mate rial___.. ---------------------------- __. Size: Diameter_- :,--_r ❑ -----.Depth------------------------------ --------------------Liquid Capacity-_-------------------------gals-M Privy:. Distance from nearest well_ ��_------------------------------------- _. .._Distance from nearest building- ------------------------ ____ ❑ Distance to nearest lot line_. ------------- ------ ---------------•--=----------------------------Ok -' '- ,,' Remodeling and/or repairing (describe �' '-�-•. r "t2'w�f==-�'- r ----------------•---------------------•--------------------------------•-------------------------------------------------- •---------------------------------------- -----------'-- --------------------------- --------------- : . --------------- ---------------- ---•---------------------------------------------------- - --- — -------- I hereby certi that I.have prepared this application and that the work will be done in accordant with San Joaquin�County ordinances, Stat law and rules a tions of the,San Joaquiii"L-ocal-Healfli Dis"f�icf ( -- ---Q --------- -- - - (Signed} = (Owner and/or Contractor) Ti#le BY=----------------- (�91�64409------------------------------------------------( ) r (Plot plan,'showing size o , location of sysferh-in,relation to wells, buildings, eft,, can be placed on reverse si e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ( - DATE ==' ------------------------- ------------- REVIEWED BY__. -- -------------------- - ------------------------------------------- DATE-----------•-------•-----= BUILDING PERMIT ISSUED--------------- tI i ---------- - DATE Alterations and/or recomme ati ns:--------------------- k,----------------------- ------------�--------------- ---�'------- -------- -•---------- � .�- - ------------------------- -- • ----------------------- --------------------------------- ---------- - - - -- - --- - -- -- - -----•------------------------------ -------..------------- r ------------------------------------ -------------------------- FINAL INSPECTION BY:----- t= '------------------------------- Date--- ----9-- `� --------- ------------------------- �.1� SAN,JOAQUIN.LO{CAL HEALTH DISTRICT. J t 1601 E.Ha:alton Ave., 300 West Oak Street 124 Sycamore Street 205 West 91h Street I Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RKVISEO 8•59 3M 3-•63 F.F.C13.