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• .FOR FFICE USE: �. -------------�� APPLICATION FOR -SANITATION PERMIT Permit No. - -------------- ------- ------------------------ ---------------------- --------- (Complete in Duplicate) r Date Issued ... _________________ This Permit Expires I Year From 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 application is made in compliance with County Or inance No. 549. JOBADDRESS AND. LOCATION--- --------------------------------------------•--------------------------------------------------- Owner's Name ,1d•4�` -C ; ----------•---•- Phone 3:- Address-----•-- ---------- ----- -- ------_----- Contractor's.Name---- --—. ! - Phone-------------- --------------- - - - - - - - - -- - ------ Installation will serve: Residence House ❑ Commercial-E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_._ Number of bedrooms—?-- Number of baths ___ Lot size _ _______.________._ Water Supply: Public system ❑ Community system [Private ❑ Depth to Water Table _0 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U?0<ardpan ❑ Previous Application Made: (If yes,dafe---._T__._'_-___-._) No 910' New Construction: Yes [/>f10 ❑ FHA/VA: Yes ®.�No ❑ r , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__._'--- --__Distance from foundation_-_ _ 07 ' Material--- -CS L ---------- No. of compartments_... ---_-__-_. ,Sizezrit _ _X EI__Liquid depth____._'Y -_--------__Capacity.,fZ:Qa-____ 00 Disposal Field: Distance from nearest well_._*-r__-._.Distance from foundation._.��_______.Distance to nearest lot line___ ____________ O Number of lines- _--A---_ Length of each �______________Width of trench-_��`�'------------------- Type-o filter material . 1�Depth of filter material__ _ ___--------Total length- ------------------------ Seepage Pit: Distance to nearest well------ -...•..--------Distance from foundation___.�f�:�::_:Dist�n�ce to nearest lot li�e__ -_w---_-__ Number of pits_____------------Lining"mMerial,4496--------Size: Diameter_ ------- Depth_,,�___ ,rl✓.r Cesspool: Distance from nearest well-----------------Distance from foundation_________________ Lining material------.___________________._________ ❑ Size: Diameter------------------ -------------------Depth-------- ----------------- - ----------------Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well _.._______.__.___.___-_--_____.__._y-----------Distance from nearest building------------------------------------i.___. ❑ Distance to nearest lot line--------- ------------------- ----- ------------------------------------------------------------- Remodeling and/or repairing (describe)------ ---------- ------ ---- ---------------------------------- ----------------------------- c ---------------------- ------------------ ---------------------------------------------------------•--•------------------------------•------------------------------------------------------------------------------ --------- I , -------------------------------------------------------------------- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ - ---- - --- �'uf`� ---------------------------------- �:�r Contractor) B ----- -x (Title}- y------------------------------ ----------------------------- ---- - ---------- ° (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------rZ. .------ -- c� :n-7-- ---------------------------------------- DATE------- 12`, � •------------- REVIEWEDBY----------------------------------------- -- ------------ -------------------------------- -------------------------- DATE----------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------- !----- DATE----- ---------------------------------------------------- Alterations and/or recommendations---------!_^t._.--I_�-`�-4-3- ------- _ 4r2.�r---- "f`-f'_ {=v s.r----.. ?-- �: _.. __��_._ ---. = �'`=- t f, ------------------------ ------ ------------------------------------------------------------------ --••----------------------.--------_-------------- ------------------------------------------------------------------- - ----------- ----------------------------------------------------------------------------------------------------------------------------------------- ------------- ---------------------- ------------------------------------- ---------------------- ---------------------------------------------------•------------------------------- ---------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:.- _ f�-- Date ,�Y, � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E-Hazelton Ave. 300 West Oak Street-.,. ,.� t 124 Sycamore Street',, �' 205 West 9th Street Stockton,California Lodi,California Manteca,California -Tracy,Co ornia t CS 9 REVISED 8-59 3M x-'63 F-P-CO.