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R OFFICE USE: ' z7-t l_�j 3 v. / � � _____-------/0-._3_d- APPLICATIV4 FOR SANITATION PERMIT Permit No. ..,_____________________ ------------------------------------------ ---- (Complete in Duplicate) g 1. -- 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. �t JOBADDRESS AND LOCATION _ G� --------------------------••-----------------------___----------------•--••---••--•------------ Owner's Name -_N , s "J 2 ----� ---- Phone--------------- - Address "'� (1 -- ------------•---___-------------•--•-------.-_-------------------------------••----------;.. ------- Contractor's Name.------- CA s1 7 -5 _ - _.:.----••---. Phone...-------------•-•-••:--------_ Installation will serve: Residence V1 Apartment House ❑ Commercial ❑ Trailer Court J�r Motel ❑ Other ❑ Number of living units: JjQ Number of bedrooms _b? Number of baths _1P__ Lot size i�'_______________ ! r G_jj_ ft. Water Supply: Public system E3 Community system ❑ Private [�epth`,to Water Table _ •� Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑'Clay Loam ❑ Clay ❑ Adobe L'J Hardpan ❑ Previous Application Made3 (If yes,date------:-------------)' No 2--'-New Construction: Yes 2--No ❑ FHA/VA: Yes ❑ No [!l___ -r 0 TYPE OF INSTALLATION 'AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sec Distance-from,nearest w II_4—e........Distance from foundation--lP__ No. of com artments_ Si ------------MateriaL-. _____-.___-_____ -._y_� ��-°_ �-C ___ ze__ -- ------ uid de h--_' .-_---.___Ca acitY... . Disposal Field: Distance from nearest well__'$ Z ...... Distance from foundationDistance "R tefl to nearest lot line___4-:--------- Number __ ®� ------Length of each line-&P- . of trench__:.�1----~_---------------- Number of lines_-_':-��__�_________________ _ ------- Type of filter material___'F4_GJ4-.--_Dep th of filter material--- �____I-__-__-Total length-----�____---_--________________,_ i Seepage Distance to nearest well_- ---------Distance from foundation__ _U-__-.__-_-.Distance to nearest lot line____-._ Number of pits---"_ _ ____----------Lining material�f1C.-k----Size: Diameter._ :--.` ----Depth----- .Z,17?�______-----_--_ Cesspool: Distance from nearest well ---____----____Distance from foundation------------------- Lining - material--_-____-__-______---_-----__-_-___. ❑ Size: Dameter----------------- --- ---- -------De th-------------------_-----------------------------_Li Liquid Capacity - - - ------gals. i/s s Privy: Distance from nearest well--------------------y--________---_---_------__Distance from nearest building________--_______-_________--_-___--__. ❑ Distance to nearest lot line----------------------------------------------------------------•----------------------------------------------------------------------------- Remodeling and/or repairing (descrik----------------------- ----------------------------------•--•----------------------------------------------------------------------------------------it! ' ----------------------------------_------------------------------'--------------------------------------------------------------.-________-_________-_____--__---__--_-_-_-__-__________-____-__----------..---------_._-___.-_ 1 _____-__-____-__________________________ --____________________---__-________--____________--__________t_ . _________________________________________________________________________________________________________________ _-..-__- _---__-____-____- -.. 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 regulations of the San Joaquin Local Health District. , (Signed)------ ------ ------- ------------- ----•----------- -------------------------------------------------------------------------------------------(Owner and/or Contractor) BY� >--- -----------�ysfem -------------------------------------------------------------------------(Title)--------- ---------- - -------- ---------- --.-- ------ (Plot pian, showing size of ot, location of. in relation to wells..buildings, etc., can.be placed on reverse side}. FOR DEPARTMENT USE ONLY i 1 ' APPLICATION ACCEPTED BY-----Q.- ....... ---- ------------- ---------------------------------- DATE---- I = ----------- ----- ---------- REVIEWEDBY-------- ----------- --------------------------------------------------------=----------------------------------•----- DATE------------------------------------------------ -------- BUILDINGPERMIT ISSUED------------------ --------------------------------------- ----------- DATE------- --------------------------------- - ----- -------- Alterations and/or recommendations:__1_ _3- -__ �- 1 - ----- �:esi -- - ► z '-- - -- 'a�,_k. . �,. � -------- -�- -------------------------------------------------------------------- � ._ r ----------------- -•-------------------------------------------- ---------- ---------------- ---------------------------------------------------------------------- ----------------------------------------------------- r FINAL INSPECTION BY:-----L SLS------------------------- Date t z' SAN JOAQUIN L6CAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street i 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California's - Tracy,California FS 9 REVISED 8.59 3M 3-163 F.P.124. 1 1 ,S � r