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Urrl(:t u5t: ------ 3a c _. _ yt < ____' --- ---------- ------- APPLICATION `'FOR SANITATION PERMIT Permit No. ._..1 � - ..-�----- - -- ---- ------ --•- -------- ------------- (Complete in Du)icate] -------- ---------- -- --- This permit Expires 1-.Year From Date Issued Date Issued ___%1111_ 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. JOS ADDRESS AND LOCATION____-4_7�•2_0,3-- ________ Owner's Name l '4 ------�� ^ry} ------------------------ Phone------------------------ Address------- f Contractor's Name---- --- -'-4-- --------- ---------------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence J�<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: --I--- Number of bedrooms -'�---- Number of baths _�__.._ Lot size -.--U-4 ---X_-_7c d------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 46.9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ET--Hardpan ❑ Previous Application Made: (If yes,date-----------,......._I No R?r- New Construction: Yes 20"No ❑ FHA/VA: Yes ❑ No ®f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic T nk: Distance from nearest well__—____.__Distance from foundation---l�-__--__._..Material__.___r_________ _____________ --- ------- Ca ac-- No. of compartments_., -----------------Size--- _ t _ ----------Liquid depth---- ----------------- p y-..-- 0Q- --- Disposal Field: Distance from nearest well_'' ---Distance from foundation.M!--_-_--._.Distance to nearest lot line___ t... Number of lines----.__1--------------------------Length of each line_.._?a__"----------..__-Width of trench__.;7L_-f._**--------------------- Type of filter materia_ yp _[A----____---Depth of filter material--ft-_------ Total length---------��--------------------------- Seepage Pit: Distance to nearestwell_- Distanrom foundation---l0__-__ _____.Distance to nearest lot line__�r _._ Number of its___ p 1-----------------Lining materia---- -o.C��. ----Size: Diameter.--iw33--r--------Depth----..-oZ*5 - --- ------- � Cesspool: Distance from nearest well-----------------Distance from foundation------.-------------Lining material___.---__._--_.,_--.-___________.__. ❑ Size: Diameter---- ---------------------------------Depth----------------------------------- -- -------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---._...______._____________._____._._. m ❑ Distance to nearest lot kne------------------- --------------------------------------------------- Remodeling ------------------------------------------------Remodeling and/or repairing (describe):--------- - ----------------------------- ---•-----------------------------------•-------------- --------------••-------•-------------------------------- 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 regu�onsf an Joaquin Local Health District. {Signed]------------------------- . --- ---- .. ( Contractor) BY=---------------------------------------- -•----------------------------------------------------------------------------------- -----(Title)------------------ ------------- -------- -._. ------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------(I-'. ----------------------------------- _: __ ______________ DATE___��__ZT 6"3/ - REVIEWEDBY--------------------------------------------- --------------------- ----- --- - -------------------------------- DATE---------------- ------------------------------------------- BUILDING PERMIT ISSUED------------------------- - ---- -- -------- ------------------- DATE.---------------------------------- -- Alterations and/or recommendations---------------- ------------------------------------------------------------------------------------- ------------------------------------------------------- ----------- -------------- -------------------------------------- --------------------------------- d ---------------------- ---------•-------------------------------------•------------•- ------------------—----• -- -- "4------� `'` e-------+---- .� ��++ �i-1�'-�� FINAL INSPECTION BY:. C"--- f [ Date -----------------------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,Corifornia Tracy,California F.P.CO. i