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FOR OFFICE USE: ------ - Permit No. .... •- --_--_. APPLICATION FOR SANITATION PERMIT _-- (Complete in Duplicate) Date issues -' This Permit Expires 1 Year From Date Issued ----------------------- + - 'Joa uin Local Health District for a permit to construct and install the work herein descrbed.Application is is hereby made to the Sanq This application is made in compliance'with County Ordinance No. 549. JOB ADDRESS; 'LOCATION_-_-- C��C._ _ 7.._ ."-------- �l�G �.Cl� ., �r �• r Phone J_2;sj - Owner's Name_.._____. ------------ --------------------- •-•-----•- -8 --------------- Address. ------.-- , ,n,- --------•......... Phone-.9 Contractor's Name........ ...... �S- 1 - ':) ''2� Installation will se-rve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I Motel C3Other [3 Number of living uni#s: ._. ___ Number of bedrooms ____ Number of baths ._/__- Lot size ... p-- ---�f� -� -------------- Private: Depth to Water Table -.5,149 ft. Water Supply: Public system C1 Community system C3p Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ElClay Loam El Clay ❑FHA/VA: Yes E] No [IPrevious Application Made: (if yes date:__________________1 No New Construction: Yes C] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) - • V - _- `"� �. > y � s S pti : Distance from nearest weir"_:______-Ditance from foundation__________________.N!afarial__------------------------------------------------- s Liquid depth----------- ------Capacity_ ------------- IMNo. of compartments--------------------------Size----------------- J Dispo I d: Distance from nearest well _______Distance from foundation.._}.Q._f-------Distance to nearest lot line_- ~-----_- n;,� Number of lines__°--------/ ------------------Length of each !ine---�p------�- Width of trench._, -.-_---------------•• _Depth of.filter. -,material---- T....------Total length-----.�Ca---------------•• Type of filter materiaL__ _t-�- ---_ t Distan to nearest lot line___.vc ------•- `} See Distance to nearest we!L_--/_©-------Distance from'foundatio �f1 __._" �r De th____. S -••----•-• V ` Size: Diameter--- ----_ ---- p A. �.00.1� Number.of pits-_;._.�______________Lining materval_____ ri�-- Cesspool: Distance from nearest we4L________________Distance from foundation--_._____-___ .__.Lining material___._____________________-____..___.. __Depth---------------------------•-- ---Liquid Capacity------------•---- gals. D. Size: Diameter-A--------------------- Privy: Distance from nearest well---------=---------- ----- --_Distance from nearest building-_ `------•=---•-----•---•- Distance to nearest Elot line-------- �-z"---3-- `--------• ••---- -------- i _ r Remodeling and/or repairing (describe):_ _ ---------- ----- ------- I _______________1__ ---- ____ _ _------------------------------_ _ _ __.._ -^ x ________------------------ ---------- `./ ` -�- ----------------- ------ ---- -- •-- - I hereby certify thaf--- -----I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,'and rules and re 'ons of the kSan Joaquin Local Health .District.- .' II - _, ------------- - (Owner and/or Contractor) (Signed) By:. `----------- --------- ---- --- r. . (Plot plan, showing size of lot,.loca#ion of system in rely ion to wells, buildings, c., can-be, .place. _on reverse side). - r- FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY__ ___________ ------- ------ DATE ] REVIEWED BY-----------------------------------------------•-------------- ----- --------f ------ ------ DATE----------------------------- -------•- = DATE---------�-------------------------------------------------------------- BUILDING PERMIT ISSUED------------------•--;------------------------ --------------------:--- - ----•---------------•" --== ---•-----=- -==-------------------------•--------------------••--------------------- Alterations and/or recommendations: : -- - - ---- --- ---------- ------ ___. ---- - ------ ----------------- Z*_ ------ --------- ---- FlNAL WSPECTION BY:..' - '--------------- Date 3 -- ----------------------------------------- --- JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 130 South American Street Trac California Stockton,California Lodi,California Manteca,California y. r:9-9 REVie ED 0-59 P.P.c D.2M 6-60