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OR OFFICE USE: �_ __ � APPLICATION F3R SANITATION PERMIT Permit Na. ___--__._ ,e, - ----- ((Complete in Duplicate)) Date Issued /6hq---o _---------________ I This Permit Ex fres 1 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 Ordinance No. 549. eZ JOB ADDRESS AND LOCATION____�dS-� �__ ------ -__-___-_ ____ __ Owner's Name. - 1!'---- ------------------------ ---• --------------- -------- ------------------- -------------------._. Phone----_-----------------------... , Address -•---• ---------- -- ---•------------ ---- --- Contractor's Na S�1� Phone. `'� �" Installation will serve: Residence M---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J__ Number of bedrooms __4_ Number of baths --!____,Lot size -__ _uf U_U_________--_________________.__ Wafer Supply: Public system 2r-Communify system ❑ Private ❑ Depth to Water Table _G-oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ef--rlardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes El--14o ❑ FHA/VA: Yes ❑ No Pj--' 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 fpundation__ 0__-__._____Material__ `__________________ P 7 q P ----- P y- No. of com artments___�._.__ _. _.._.__Size..._�__k_�:X _-- Liquid de th_._.�__�_ ______.Ca out ,F-oqg- Disposal field: Distance from near well._._____Distaance from foundafi� ..5?_________.Distance to rest lot line__c�_�_____ Number of lines__._____ __________ _____Length of each line_____`7______-------------Width of trencA___.vZ_ ------------------- - '__________...- Type of filter material___ .� ------Depth of filter material_,� 7-__----._Tota�gth__-___---©__�_____________ �fl ----------- r � Seep s Pit: Distance to nearest well-----_. ------------Distance � ` ___ _-________- q ___ __._.____ ve Number of pits- -- 7_ ________Lining material__ /._0t__Size: Diameter _—_ ____________- Cesspool: Distance from nearest well----------_------Distance from foundation------------------- material---.------.____-__-_._______________- r E❑ Size: Diameter--------------------------------------Depth_-------------- --------- ------Liquid Capacity--------------•------ ------gals. rrl Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----._____._____________________._._____-- ' ❑ Distance to nearest lot line----- ----------------------------------------------------------------- ---------------------•----------------------------- --------- ------ Remodeling and/or repairing (describe):--------- -------------�, ----------------------------- ---------- -----------------•-----••------------------------ -----------------------------------------------------------------------------•--------•--•---- -----------------------•---•-----------------------------------, it ----------------------------------------------------------------- 1 ----------------------- •- - ----- ------- ------ ----------- ------------------------- --•---------------------------------------------- ------------------------------------------------------ ------ I hereby certify that I have prepa ed fhi application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an egula ions of the San Joaquin Local Health District. (Signed)---------------------------------------------- ------ ----------- -------------------- -------------------------------------------------------------------(Owner and/or Contracforl By:---------------- ---- ----------- - ------- ----------------- ---------------------------------------------_-- -"- (Ti+Ie}------ - ----------- (Plot plan, showing size f , oc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ------------------------------------------------------------- DATE------- �'�Q__-7 .- ---------------------- REVIEWEDBY-------------------------- ----------------------------------------- •--------------_.- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED.-•-------------------------- DATE------------- -------------------- ---------------------- Alterations arid. or recommendation/s:____ ___---=`r.____ -e_ 4- E - - s-�£ r -�-<_ c.�mss-z ---- --t _ z t -- =j c. ------------- ------•- ---- Y_v •------ -c..-moi. -e FINAL INSPECTIONI,G�a_-------------------------- /0 �y 6-P---- Date ----------------------------- ------------------------------- + # SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California r Lodi,Californias Manteca,California J Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.p.CC.