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FOR OFFICE USE: —1 All APPLICATION FOR SANITATION PERMIT -- --- Permit Na. ---•----••--,•-------- r � I -- (Complete in Duplicate) _ I ^: x Date Issued ------R2/_�y VA �`"-. This Permit Expires 'I Year From Date issued � --------- ------- - 1 / 13—cam s1 ict for a permit to construct and install the work herei Application is hereby made to the San Joaquin Local Healfh Distrn described. This application is made in compliance with County Ordinance No. 549. � 0 r:Se—_2-tAY_ i4 FT=C E u�s 1 w. JOB-ADDRESS AN LOC TION_._!_/__ ------ /� 3Phonel _ lf _ _.----------- '---- - - 1 Owners Name---------- ------ ------- -------- - ----- - -- - - -- C� Address----------------------------X ---�---- �r�.------------• = ----- Contractor's Name-------_- - - -------- Installation will serve: Residence �' Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: ��._-__ Number of bedrooms _ Number of baths _ .YLot size -----O----------- ------ --------------- Water Supply: Public system E1,*Community system ❑ Private X Depth to Water Table -2--P ft, Character of soil to a depth of�3 feet: Sand Gravel ❑ Sandy Loam ElClay Loam E] Clay C] Adobe [3 Hardpan El Previous Application Made: (if-yes,date---_--_ ---.----) No 9 New Construction: Yes ❑ Nog FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Sewer-.-is available within 200 feet.)jo Distance from foundation________________.Material___-__-.____-__-_------------------------------- arice from Septic Tank: Not of compartme est.well---- 'Size Liquid depth---------------- ---------Capacity..-------------------- ❑ ` r �__---Distance to nearest lot line-/ ...-- N Distance from foundation__.Z0 Disposal Fie�l Nure6er of lines e from earest/ell--��---- Length of each line-------/€ ........ of trench--------- ---------- Gl� Type'of filter material___ A'.'____2-,Depth of filter r'ateriaL*_._-_lF__*.--Total length-----------------___inn.......... 1 J Seepage Pit: Distance to nearest;well_________________ _Distance from foundation---------------------Distance to .nearest lot line__-_-.-______--__ Number of pits---------------------Lining material-------------- ---------Size: Diameter-----------------------.Depth----------------------- i ❑ r > i Cesspool: Distance from nearest well_________________',Distance from foundation--------------____.Lining matenal--_-___.-____.-_______________-__-._. `De th --------...Liquid capacity----------------------------gals. ❑ 'Size: Diameter---------------------------- p t � t 1 Privy: Distance from nearest well------------------ - _--:----------Distance from, Barest building--,; - _____;-------- ❑ Distance to nearest lot line----------- 1 -------------------------------------- -------------------- C f Remodeling and/or repairing (describe):----------4 `iPf__-------=�------.._��LST//✓�----------,� 1"7 3 ________________________________________________3____-_-_____--__._- ----------------------- ___.__-__-____ __-.___.____ -------------.___-___... ____________________ ______ __-- ___ ------------------------------ ___. t ___.__a______________________ L -1 _ _ ______________________________________________________________________________________________________________________ ____,-__.------------------ 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'requlations'of the San Joaquin Local Health District. Iczan Contract , _--, -------- :.(Ownpr dor. or (Signed) 13 5.• �- F ----------- �Y=------------ (Title)---------- __}..---------- -- ' --- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc.,"can be placed on revere side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - - ---------------- '�„".. DATE_. ` ) ' -- --- ------------------ ---------- - REVIEWED BY ----------------------------------------- s. DATE-------------------------`-- -----)----------------------- -------•--------- ------------------- - BUILDING PERMIT ISSUED-------------------------------------------------------------- - -- DATE ' t ------------•-----------•-------- Alterations and/or recammendations:._______________ ---------------------------------------------•-- } �, -- •--------- " --------# ' ------------- -- ------------------ ------------- - ------------------ = ------------------------------ - ---•--------------- ------------------------' ' - f ----------- ---------------------•------_----- ' I It f -� -------------------•------------ ------- -------------------- -------- ----------------------- -------------------- ' :'---------- ----------• ---------------------' - f r .�.... a ,� �..--�.".�—.�.....,� ..d-.:r .-...tea--'aw" 'f ' ^�--°yr""+�-•-� ---------------- ----------- FINAL INSPECTION BY--------------------- . -. --- Dafie � 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 S-54 3M 3-'63 ".Co-