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r FOR OFFICE USE: u ' - ------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..1_.7_cf',3d ... ------------------ - ----------------------------------- Com tete in Qu ltcate / p P• ) Date Issued _� > __ ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / t - ------•----- --- JOB ADDRESS AND LO AT10N________________ ___T_ ___- Owner's Name--------- � eGl-.d. Phone i : Address------------------------ ------ - ------ --------------------------- - Contractor's Name_, ---------------/_'o - ---- installation will serve: Resident/eA Apartment House ❑ Commercial ❑ Trailer Cour ❑J /Motel Other ❑ Number of living units: _[.---- Number of bedrooms --%I--- Number of baths e---- Lot size3-r_ _7/ - -----------•--- Water Supply: Public system ❑ Community system ❑ Private,V Depth to Water Table A_S"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,® Clay ❑ Adobe tp Hardpan'T Previous Application Made: (If yes,date--------------------) No New Construction: Yes J� No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: C)j (No septic tank or cesspool permitted if public sewer is available within 240 feet.) r Septic Tank: Distance from nearest well DistanF� fro 1 foundation----/?2 ------.Material-- Size-1 ` - e _ No, of compartm --ents- ---------- -------Li quid dP.th - - Capacity --------- Disposal Field: Distance from nearest well_�q-------Distance from foundation__f-#_'_,___.__.Distance to nearest lot Zine._____.---..... Number of lines-__-__ -_ __ Length of each line___, Ub--__ n Width of trench.'' ______________________ - Type of filter materia _ Depth of filter material___- __ ___.___Total length___.�+.�-----------________-------- Seepage _______ _ - -t4 i See a e Pit: Distance to nearest we I�U"--___________Distance from foundation___= -' _____.Di t rife to nearest lot li�le_�.____.___. g JJ '' --•- } r Number of pifs.-ol-------- Lining material;*kr�!?_---------Size: Diameter--- ---------.Depth__.._-..__._......___________ Cesspool: Distance from nearest well------------------Distance from foundation.... --------------Lining material_____________________________________ Size: Diameter--------------- - -----.De fh------------------------------------ I -- -Li `uid Capacity----------------------------gals. O Privy: Distance from nearest well-------------------------------------------------Distance from nearest,building------_--___-----------_------_----___.._. ❑ Distance to nearest lot line------------------------------------------------ %` Remodelingand/or repairing (describe):--------- ---------------------------------------------------------------•-•--------------------- -------------------...------------•-••---------------- I I --------------------------------------------•------------------------------'--- -----------------------------------------•-•----------------A------------------------------------------------------------------ ---------'-------------------------- !-----------------------•---------------------------------------------------------------------•-------------------------------------- ------------------------------------------------- I hereby certify that I have prepared this application and that the'work will be done in accordance-with San Joaquin County /0 ordinances, State leaws, and rules and regulations o theSanJoaquin Local 'Health District. Si ned ` - _______________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). Ay FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. = � x -------- DATE---k-;� '�-------- -- - REVIEWED BY----------- --------------------------------------------------------------------- ------------------------------------- ----- DATE- . ---- -------------- -------------------------------- BUILDINGPERMIT ISSUED---------------- -----•------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------- ----------------------------------------------------------------------•--------------------_----- ------------ ---------------------------------------- ------- --------------------•-----------------------------------------.--------------------------------------- -------------------- ------ --------------------- ------------- FINAL INSPECTION BY --- --------- Date.- �/f(p — ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.P.CC.