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FOR OFFICE USE: IL- 001 Y q rZ_ j_k --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. � _ ---------- ------------------------------------ --- (Complete in Duplicate) Date Issued �,�_-�...1•- 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. JOB ADDRESS 4ND LOCATI N---•I -------------� " ,..�%C ................................ Owner's Name.••1 - -- --- -x---- - --�- - -- ------ Phone--------------------- Address---•---�-1----)^ -- ----1 G4 ------ ---••-•--••-••--------. Contractor's Name--- -- - -, -.A.. ---- . --- ------------------------------------------- Phone----------------------------------- Installation will serve: Residen Apartment House ❑ Co ercial ❑ Trailer Court ❑LL Motel 171 Other ❑ Number of living units: ---I--- Number of bedrooms _./--- Number of baths ---/-. Lot size _-____----_ Water Supply: Public system ❑ Community system 0, Private ❑ Depth to Water Table j,- ft. Character of soil to,a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayx Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------_----------) Nox_ New Construction: Yesit No ❑ FHA/VA: Yes ❑ Nq TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is vailable within 200 feet.) Septic Tank: Distance from nearest weIli�_/L7ista fro 00 �-----I a-------.Ma�rial------- ----- ... •. .• ....-------- No. of compartments-_----'''-------------Size____. __..._. ?Liquid depth----_.___.__._..-_______Capacity.. _ ,- _ _. Disposal Field: Distance from neares 1bAP__Distance from foundation__A.�p........Distance to nearest lot I'ne.�... [� Number of lines -`��,—�,-_,-„.��ength of each line_-___- .. j.....Width of trench._�._�j�__________________•__ ` Type of filter materiaLS.l--rte- =^��epth of filter material____�_ _____.__.Total length_____._.gj------•-----_--_.---_•- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Dept h-------------------------____-__.- 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):-------------------------------------------------------------------------••---------•----•-..............................---------------------•------- 'V -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- ------ 4 ------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------•-•------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordin es, Stoe_laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ = `' - ” _.. I------------------------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------- ------------------------ -- -- ---..------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ REVIEWED BY----------------------------------------------------------------------------------------------------- DATE-- -- .� ------- --------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- / / ---- Alterationsand/or recommendations--------------------------- ----------------------------------------------------------------------------------------------------•---------..............-------- --------------------------------------------------•------------------------------------------------------------------------------------•-----------•------------------------------ - .............•-•-------•----------- ------------------------------------------------------•-....-••-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- --------------------------------- ---------- ------- ---------.-..-------..------------------- ----------------..- J / V ------�- ------ Date----------/ 1C FINAL INSPECTION BY------ --- ----------- ----��-�� --- ------------------------ ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.P.CD.