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FOR OFFICE USE: --------------------------------------------------------- -------- -- ------------------Z---------- -------- --------------------------------------------------------____________ ______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ---------- -------------- (Complete in Duplicate) / -------------- ---------- - -------------------- --- -__ This Permit Expires 1 Year From Date Issued 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. ;f C}=! tl bow JOB ADDRESS ANQ LOCATION - 4 '" Owner's Name__�`.ti�✓------- -- - -Q ' -- ------------ - Address__&/-a7�-__&_. •- i -- + Conme_ tractor's- Na _ ` ___ T - — — "�__. _ . - sem. - -------------��'-`--��-----...-- ---------------. Phone-'--------r,. . Y-- . Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ Number of living units: --- ___ Number of bedrooms �. Number of.baths "_ LOt size ___ '�-$ E'er.-1�.�-------------- Water Supply: Public system ❑ Community system ❑ Private RrDepfk to Table -------- ft. haracter of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Loam ❑ Clay ❑ Adobe ❑ Hardpan E] } lica �' Previous A 4 pp 'tion Made: (lf yes;date.__..-_"..___.______} :No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE:OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ank: Distance from nearest well_____. R_ p� i Distan`efrom �oundaion_-____� ._=__.Material..__"�({ C_ P� """__-._f_-________" 4l No. of com artments--___ _ Size_ __--Capacity___ _ __ '" - p �--1---x-�-X--r---..Liquid deRt�----------�-- -- Dispos ' d. Field: Distance from n arest well_.__-_�'� !--_Distance from foundation.-,.--- Distance to nearest lot line__ Number of lines_________" Length of each line_"_----- a ' � 7 -- Width of trench =----•------------------ "y Type of.filter ma terial___-_rt14 _l_------Depth of filter material------/___7-_- __._Total length--------- --------------- mss) Seepage Pit: Distanceto nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------. _"._____ N -�, ❑ umber of pits____________________Lining material__-___________._____...Size: Diameter__..-____._._" ---- ----Depth........................ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------- - I ❑ Size: Diameter ------------------------------ ----Depth----------------------------------------------------:Liqui. --d Capacity __-gals. N Privy: „� '*� .Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------_----___--. ❑ '"# Distance to nearest lot line______________ Remodeling and/or repairing (describe)___________________ } _________"_"__.__"-_.__"_____________"__.._______"_________._____"__-_.______.___._-__-________-_---___-----___---.-______f-___--___- Y 3/ � ----------_---------------------------- _______________"____.______.___"___"____.--_________-______________-__ _ --------------------------- I----- - t 3 - - --- ---------------------------- -------------------------------------------------------------•---------------------------•-------- .. �fir. - _ -------------- -- --------------------------------------------•---------------------------------------------------------------------------------------------------- ------•----------------------------------- - -- I 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 regulafions of the San Joaquin Local Health District. . Y T (Signed) _ k y€ r � r and/or Contractor) B [ _ _T- --„ - - Y� ,..: • :. _--- . -- --------------------(Title)------------------- -- --------- (Plot plan, showing size of lof, locaiori of system 4Telation to wells,.buildings, etc., can be placed on reverse side). ,FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY'_,! : ------------------------------------------------------- DATE-Z— 1- ---- Irj REVIEWEDBY 0--------- •--- ----- --- - ------)`' ----------------------------------------------------------- -�- DATE----------------------------- --------•------------- ------ ' BUILDING PERMIT ISSUED-------------- -------------------- ------------------------------------------------------------- DATE--------------------------------------- Alterations and/or recommendations:-------------------=--------------- ------------ ---------"--------------------------------------------"•-----------------------••-----------------.•---------- -r --------`_------------------------------------------- ---..""_--.._--- __._-4 ----.-------------------------------__---------------------------------- --_-._--------------------------------------- ----------------------- e_ 1 f ..............................._____._____...__-_-__"_._.______-_-____....._.____._.____.____...___-__".___.__-____.__._____-_.___.______.__...__-____.__.-.--_-___._._--_____...____---__---._._-________._-__-_____-..- { FINAL INSPECTION BY. --------------------- Date--- r. -. --------- ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CO.