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FbR OFFICE USE- --------------------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._?�.724S. . =: (Complete in Duplicate} f/ -------------------f--------- ---------------------------- This Permit Expires 1 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 described. This atppiication is made in compliances with County Ordinances No. 549. O 657- �O /1 PO JOB�NDD ESS AND TION-1 -- C��-� '`' - IM � � Owners Name------- -Y✓ - 4� Phone -------- - ----------------------------------------------------------- Addr'M ass f � 6 � .... ... -------•-•--------------- ----•-------•--------•--•---•--------------------------••---- Conti`ctor's Name--- ----------------------N �. -- _e --- Phone.... Installation will serve: Residence J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __j---- Number of bedrooms _!-- Number of baths _-1-_- Lot size ------- - -- ------------- .Water Supply: Public system ❑ Community system ❑ Private Er-`Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe I] Hardpan ❑ Previous Application Made: (If yes,dat'e--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1E(No septic tank or cesspool permitted if-public sewer is available within 200 feet.) ' a r � Septi ank: - Distance from nearest well----- --------Distance from foundation------j-�Q---.__.Material------- _ _ --------------------- No. of compartments-------:) _ . Size- 6 r-- _-_1[_ _Li u id de th.----- - 'Capacity--- Disp6V Fie}d:- Distance from nearest well_j—C-_ ._Distance from foundation------h_'---Distance to nearest lot line-,5.......... Number of lines-------- -------- ---- ---------Length of each line--------11--00-_;-----r.Width of trench---- ----- ------ Q. ,,��jj Type of filter material-- _ __._k--------Depth of filter mate ria l____��_`_..... --Total length--------`-P2_U'._------------------- LN r t ' i _ ?h Seeps Pit: Distance to nearest well----- -.----Distance frj m,foundation-----/_Q-._-._-_.Distance to nearest lot line-- ----------- Number of pits-------.7---_______Lining material__ji-h.--------Size: Diameter.'._-S.;�_ ___-Depth---. -.. --_-----_-__-__-. Size: ce f ro'er------------------__-----------------Distance from foundation---.-.-._-_--------.Lining material------------------------------------- E --____------_:__--------_.---_-.--. �. Cess l.00l: Distance fi•or� nearest wail---- - p w .. , C) - ----------Depth---------------------------------------------------Liquid Capacity- --------------------------gals. 11510, ----------____------._Distance from nearest buildin ts Privy Distance from nearest well-------- =---------- -- g-- -,------------------------------------ Distance to nearest lot line_._.--------------------- ---- = .. Remodeling and/or repairing (describe):-------- -----------------------------------------•----•----•-------•-------------------- ............. •-------•--.- ...----------------• -•-... ---------------------------------------••------------------------------------ -------------------------------------------- - - k -------- -- -------------------------------------•------------------------------------------------------•-------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordindances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signk d)------------ ------------------ - - --------------------------------------•--:---------------------------- -------- id/or Contractor) -- I - --------- By:-------- --- --I ---- Title------ -------- -- ----- --- (Plotliplan. showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' - yREAPPLICATION ACCEPTED BY------�--------- ------------------------------------------------------ BATE---r;:7-- --------------------------------- REVIEWED VIEWED BY--------------------------------------------- --------------------------------- ----------------------------------------------- DATE.------- -----------•--------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- - -------------------------------- AlteNations and/or recommendations:----------------------------- ------ - - ----------------••-----------------------•------------------------...----•------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------- ---------------------------------------•--•-----•-------------------- -:----------------------------- ------ •----•------------------------ ----•-- -------------------------------------------------------------- ------------------------------------------------•---•----- -----------------;----------------------------------------- i - I FINAL INSPECTION BY-/ -- ' .. .-- .- . '~3� G -- -�� ----------- - ------------ Date---- - - --- -�_,...._:.--------------------------------= SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ESi9 REVISED 8-59 3M 3-•63 F.P.CD.