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FOILOFFICE USE: APPLICATION -FOR SANITATION PERMIT Permit No. ./ .k ..5 .. -- ----------- ------------------------ ---- - ---- -- tComplete in Duplicate) // ........................._____.._._._.-----.-------- This Permit Expites,l Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This plication is made incompliance with)County Ordinance No. 549. mrc 14 , JOB ADDRESS AND LOCATION.___ _________________ u Owner's Name [�_�f_ _ = ------- --- Phone7 _�_ '._-/. 5 y ` ! ----------------------------- Address--------------------- ..�. ...--- �E_'_EFt9_17 -_ �---•-----------••---- Contractor's Name-----011VAfJF_j: ---------------------------------------------------------------------------------------------------- -------•--- Phone--------_-•---........--..--•---- Installation will serve: Residence �'e Apartment House E] Commercial El Trailer Court E-] Motel F1 Other ❑ Number of living units: L-.---- Number of bedrooms__ Number of baths _I____ Lot size ___ 7 ____k______3_O�__:_____________ Water Supply: Public system F] Community system E] Private ❑' Depth to Water Table -15-- ft. Character of soil to a depth of 3 feet: Sand,d' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No d' New Construction: Yes&J- No ❑ FHA/VA: Yes ❑ No ❑- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is-available-within 200 feet.) - - - • - 4, Septic Tank: Distance from nearest well-54?-----Distance from foundation--__,f Material ____CONC—R_I'`.7— No. of compartments__--___. -..........Size-_ _�( _ ___Liquid depth___ ----Capacity.. C0 Disposal Field: Distance from nearest well...5-0--_-Distance from foundation_ ----------Distance to nearest lot line. -- 0� Number of lines----------�•----------------Length of each line______ �____`.p__._.Width of trench._----- u�_"-1 -- Type of filter material__A C-��______Depth of filter material------/ -------------Total length_______________'_ _ _____________ A Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_______________ ❑ Number of pits______________________Lining material-__ ----Size: Diameter.----------------------Dept h--------------------------------- 0 Cesspool: Distance from -well___-�-__-_Distance..from foundation-_ _ ___ Lining material_____________________________________❑ Size: Diameter-[ear6sf ----------------------------------Depth---------------------------------------------------- quid Capacity-.-.------ -----------------gals. Privy: Distance from nearest well---------_______________-________________.____Distance from neirest building----------------------------------------- ❑ Distance to nearest lot lire--------------------------------- ----------- ----------------------------- Remodelingand/or repairing (clesIribe)---------------- --------------------------------------------------- -- ---------------• ------------------------------------------*--------------------- --------------------------------------- ------------------ ---------------•------------------------------------------------------------------•------------- I - ----------------------- ---------------- -------------- - -------------------------------------------------------------------------------------------------i----------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County o4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- --------------- ------ ------------------(Owner and/or Contractor) -By: -------------------- Title r _ - -_ _._ ---[ 1----------------------------- ----------.. . .. - - ------ (Plot pian, showing size of lot, location of-system in relation to wells, buildings,.etc., can be.Paced on reverse side). •FOR DEPARTMENT USE ONLY -3-- -Al APPLICATION ACCEPTED BY-------.---�--�,-a'----------------------------------------------------------------------- DATE---- 6:��--_--_-- REVIEWEDBY--------------------------------------------------------------------- ---------------------- ---------------- ---------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- All t�ations and/or recommendations---------------- - ----- ------------- ---------------------------------------------------------•-----------------------•-------•------------- --•-------------- - s-----------------•---------------------------------------------------------------------------------- FINAL INSP TION -------------a0,L;r7 Date--- - -------- -� r� ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street L Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3-'63 f.P.CO.