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FOR OFFICE USE: 2,4191 f APPLICATION FOR SANITATION PERMIT -------- ------- -------------- - -------------- (Complete in Duplicate) Date issued ---,7 ---------------------- ------ - --------- ---- ------ ----------------- This Permit Expires I Year From Date Issued ade to the San Joaquin Local Health District for 6 permit to construct and install the work here-in descr Application is hereby m ib 053 - 0-0 This application is made in compliance with County Ordinance No. 549. 1,'71 Y ---------------- jZR ..... --- ---------- 2-,0 A) . `1( .A _ _- ------------ JOB ADDRESS AND&OCATIO�N1,41-4-)'-----WOAA" ._r----- -- ---------------- ---------- Phone------------------------------------ ----------- --- Owner's Name -- ----- ---- -- ----------- --------------------------------------------------------------------------- ---------- --- ----- ------ ---------- --- --- ------ -PLY--- ----------- Address----------- .......... - Phone.. ------------------ ---------- ---- ------ - Contractor's Name---- Installation will serve: Residence [Apartment House 0 Commercial Ej. Trailer Courf .0 Motel 0 Other El Number of living units: /:.-- Number of bedrooms 7-i NuMber"o. baths -------- Lot size ------ -------------------- Community system F1 Pri ��Dept,� to Water Table -------- ff. Water Supply: Public system 0 1 — r -1- - Clay Loam El Clay [:3 Adobe E] Hardpan Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam Ej --) No Fj N e,�.-Construction: Yes E] No 0 FHA/VA: Yes ❑ No El Previous Application Made: (if yes,date. -------------- TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-49--------Distance from foundation----/.A---------Materia�-------------------------------------- Septi ank: iquid clep�h----V---------------------Capacity-9-0-0 11 -------- ---- ----- No. of compartments-------------------- ---17 "___---Distance to nearest lot IiineXx ------- Distance from nearest well----5�i-------Dista`nc'e from founclatio Dispo Field: . /. idfh of tren&----X-�---------------------- I -,K, -1 ---LengtIn';of each line..._-_--Cn---- ----------W 9 1 Number of Iines7'-:------------------ ---- A ----------------- Ty'e of filter rial---------6----)ZI--- D th '-f filter matefial-----------/-f.......Total length---.- P fer mate ep 0 f - S I Stan t lot line..."....""-_-__._well-1-112-0-------Distan(f0rom fQundation-----1-A-------Di ce-to neares See Pit: Distance to nearest N ..S�ze: Diamefer-------- 0 Number of pits-11. ng material------- ------------ /� e 1, - ---b----------.Lining - -foundation -------------------Lining material___....__..___-_"__....__"..._...._- Cesspool: Distance from nearest well-----------------Distance from --------------------------gals. I I ------- ----Depth----------------------------------------------------Liquid Capacity Size: Diameter- ----------------------- El ;4 'tance from nearest wel�---------------------- -------.___-;-----------------Distance-------Distance from nearest building---------- ------------------------------- Privy: Dis ------------------------------------ 7------------------------- Distance to nearest lot line. - ------- ---------------------- ---------%-i-------------------------- ❑ 0� -I ---------------------------- ------------------------------ --- ------- - repairing (d r -------------------I---- --- ----- --------------- Remodeling and/or r ----------- ---------------I--------------------------------- ------ --- - ----- ---- -------------------I----------------------- ................. ........ ---------- ------------- -- --------------------------------------------------------------------------- ......... --------------------------------------------r---------------------------------------- - ------------------------------------------------------- I - -------------------------------------------------------------------------------- I hereby certify that I have prepared this application and t - ----------------------------------- --------- -------------------------------------- hat the work will be done in accordance with San Joaquin County ordinances. State law an rules and regulations of the San Joaquin Local Health District. ------------------------------------------------ ------ ---7!7�and/or Contractor) (Signed)----- _..y- ---------------------2-.—------ --------- ---- --- - ------ ----- -------- ---- ------- _ o +;wells, buildings, etc., can be placed on reverse side). (Plot plan- size-5 ze- -T fern in re ion ti FOR DEPARTMENT USE ONLY -- "p ------------- --------------- -------------- -- APPLICATION ACCEPTED BY- ------ ---------- -------------- ---------------------------------------- DATE-.--,7- - REVIEWED BY------------------------- ------- ----------- ------------------ --------------------- -------------------------------- ----- DATE-------------- -------------------------------------- -------------------------------------------- ----------- --- BUILDING PERMIT ISSUED-----------= SSUED------------------------------------------------------------ ------- ------------------ DATE. ------------------------------------------- --------------- ----------------------- Alterations and/or recommendatio'ns:--------------- -------------------- -------------------------------------- --------------------------------------- ----- ---- ---------------------- ------------------- ----------- -------------------------------------------------------------------------------------------------------------- --------------- ---------------------------------------------------------- ------ --------------------------------------------- ---------------------------------------------------------------------------------------------- --------------------I --------------------------- -- ---------------- ------ -------------------------------------------------------------- ---------------- ---------------- ---------------------------- ----- ------------- ------- ---- ---------------------------------- --------------------------------------------- --- ----------------- -------- --------------------------- ------------ -------- ------------------------- ------- ------------ . ---------------------------------------------------- FINAL INSPECTION BY:.../A4 .-- - ------ Date 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 F.P.Q13.