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n F OFFICE • P. -�--------------- -%-------- ----------- ------------------------- --- Ey' APPLICATION 1=0R SANITATION PERMIT Permit No. ------- --------------=-------------- ------------------ (Complete in Duplicate) -- - This Permit Ex ires 1 Year From Date Issued Date Issued __�/57 X 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 t4p. 549. JOBADDRESS L CATION ------- i---- ---------------------------- -- - - • ---- -------- ---------- ---------------------------•--------------------------------------- Owner's Name-- •--- • - --- --------- ------------- Phone------------------------------------ �& Address---------1--,z�- { Contractor's Name---- --- -- 4-- ----------------------------------------------------------------------•---------------------- Phone.-_-------....................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court E] Motel L] Other Other Number of living units: __ ____ Number of bedrooms _ 1_ Number of baths ____._ Lot sizeX-_---__________________________ Water Supply: Public system &--c—ommunity system ❑ Private ❑ Depth to Water Table _(oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe CT—`Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes Er'-No ❑ FHA/VA: Yes ❑ No R�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep,t.}}'�c 4 Distance from nearest well-, _______Distance from foundation/ ____ Material-- -. LICapacity.--P-------- ------------------------------- r GQ 44- No. of compartments_.-'L-________________Size_...- -QC_a_�_.l-_:---Liquid dep? k----- ----_--------- r Disposal 'eld: Distance from nearest well_4_---------Distance from foundation_14_____________Distance to nearest lot Number of lines_________I__ _ Length of each line____- ' {' --- -- ------- 9 --d- ----------------Width of trench..`.-�---.------------'-- ---- De Depth of filter material_f�_y__-.-------Total length...... p___'-------------------------- Vl Type of filter materiZ G p Seepage Distance to nearest welf_.__"—___.._______Distance from foundation-/D------- ------Distance to nearest lot iine__4— 1 10 Number of pits.;_-----------------Lining material_`_�Et_LAf---Size: DiameteR,'_'?„3___a�-----_---Depth---Z_cS-"----------------- 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 __-__._____________- ________.__..._Distance to nearest lot line. - ----------------------------------------------------------------- Remodeling and/or repairing (describe): ------------------------------ ----------------------------------------------•------------•---------------------------------------------------•- ----------------------------------------------------------------------------------------------------------- e. ----------------------•------------------------------------------------------------------1_____1--------------------------------------------------•------------------------------------------------------- -------------- - ----------------------------------------------•---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application 4fid that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations theS n Joadijin Local Health District. (Signed)-------------------------------------------------------------------- ----- - - - ---- --------------------------------------------•-------------------(Owner and/or Contractor) By: ---------- ----------------------------------------(Title)--------------- ----------- -------------- - -------- ------ (Plot plan, showing size of lot, loc 'on relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ft ---- ---------------------------------------------------------- DATE--------I-'/.S_�~ REVIEWEDBY------------------------------------------------------------------ --------------- -.._. DATE BUILDING PERMIT ISSUED-------------------------------- ------------------------------------------------- ----------------- DATE Alterations and or re mmen at' ns:._ ___.__-_. __ _ ------------k 0:747 ---------------------------------------------------- _ r E ' 1 --------------------------------------------------- --------- - --------------------------- f--- -- _: ------------------------------------------------------------------------------------------------------- ---------•----- ---- -------------------------------------------------------------- ----------------------------- �+ c-- FINAL INSPECTION BY:............ - `r c-tt' Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Cofifornia Tracy,California CS 9 REVISED S-59 3M 3-'63 F.P.CD.