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FOR OFFICE USE: ------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Perini+ No. _.�_-7�___-___.._ -0 ------------------,_--:-- _ -------. (Complete in Duplicate) f _ I I Date Issued .�`' ------------------------------ This Permit Expires 1 Year From Date Issued I 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,complian!ce,with C unt Ordinance No. 549. Opp _irg0- �b .,;-.L044Is,+-A-USE , XV, JOB ADDRESS AN CATION_ . ---h�lLC -- •---� • pp � - ----_q---fir--------------- - - �+..E'.-��------ 'dc.t�Lv� Owner's Name - xa `'..r----- l --=----- --------------------- -------------- phone...........-•-------•--------------- r 77 ! Address__....----• -- �..) {---• �-�------ ------ ------- -------•-----••---------------------- ------------------ ----- ------------ -- Contractor's Name------------- c- ------- - -- - -- - -- ---- -------------------- Phone--",-------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ iOther ❑ Number of living units: -/_Number of bedrooms ___ ___ Number of baths __L-_ Lot size _______________________- ____-___-_________________---___ Water Supply: Public system ❑ Community system ® Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;-date------- --------1 No ❑ New Construction: Yes E-] No E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted-if-public sewer is available within 200 feet.) { Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material __________.__f--------._----______...________- 4 ❑ No. of compartments--------------------------Size-=--------------------------•---Liquid depth---- ------- ------------Capacity--- --- ----------- _ 1' Dispo Field: Distance from nearest well.- ----------Distance from foundafian'/ __!_.Distance to nearest lot l�e______r-___--- 45` Number of lines___._:_______ _. Length of each line-------- 0___t_.__ _ __.Width of trench. ___`__ ' 1 r ------------------- Type of filter material___ r }_----_Depth of filter rnatenaf____._ __.Total length________ Q__________________________ Seepage Pit: Distance to nearest well—--------------------Distance from foundafio_n�__=___:- y__.Distance to nearest lot,line----------------- D ❑ Number of pits-i--------------------Lining material----------.----------- Size: Diameter----------.............Depth---------------------- S --------------- Cesspool: Distance from nearest well------------'___Distance from foundation!------------------ , '------- ----------- r •: Size: Diameter------------------------- r De 'th � .._________.___Liquid s► Capacity_. ___________gals. Privy: Distance from nearest well ' �______... ___________________ __Distancefrom nearest building ________ _ = --____ _' _-________ _____________. ❑ Dist � { ' r---`------------------------------------------------------ - •------•------------------------------------------------=-:----- -------------{ Distance to nearest lot line----- - 1 . Remodeling and/or repairing {describe:_____ _.____ ______________________ ' ----- '; ---- ----- t ------------------------------- --------------------------------- ------ 1 `------------------------------------------------------ -- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate-la . and rules and regulations of the San Joaquin Local Health District. + S (Signed)•----- --------- - -= ------------------ -•- - -- -------- ------- ----------------------------------------------------------------------•-•-�+er-Re+df or Contractor) ,. By-------:---- �Xlls. -------------------------------{Title)-------------------- ----- -----------... ------ ` (Plot plan,.showing.size of lot, location of system in relationuildings, etc., can.be placed-on reverse side). f f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ __�--------------------------------------------------------- DATE---j-- Q' . REVIEWEDBY---------------------------------- -------.---------=--- ---- - -------------------------------- DATE------------------------------- BUILDING PERMIT ISSUED------------- £--------•-------------- -------- ----- ------------------=------------------------._-DATE------------------------ Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---- ------------ --- -----•---------------------•--------- ---------------- ----------------------- ------------------------------------== ------------------------------------ --------------------- ----- ----•------------------------ -------------- ---------------,r..- --- ---------------- -------------------------------------=---=--------------------------------------- ----------------------- ------------------------------------•----------------•-- ------------------------------ -- ----------- ------ FINAL INSPECTION <,B.Y,.: --- --------------- Date "-��-- SAN JOAQUIN LOCAL HEALTH DISTRICT .._�.� 1601 E.Haxelton Ave. 300 West Oak Street'"• - 124 Sycamore Street 205 West 9th Street . St- -V_ Stockton,California Lodi,California Manteca ,California Tracy,California E5 9 REVISED 8-59 3m 3-'63 F.P.gp. r