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FOR OFFICE USE: } APPLICATION FOR SANITATION PERMIT Permit No. .. .,/ ..,[-�J --------------------------------------- (Complete in Duplicate) �117119�1 .__..__. This Permit Expires 1 Year From Date IssuedDate 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. JOB ADDRESS ANQ CATIO _. 1 / 1- `'11 1!---=-=��'�----------------------p----- Owner's Name •- d�-t��` ""`--' - ------------- Phone_ . �_f_s__--- •------------ Address %�+r � .e fi.Jr- -- e- ------ � ..� Contractor's Name- -'�r5----- .---- --•--------!_<- `i1_ _. f �. � f_r---••-----------------••---- Ins+allation will serve: Residence 9_ rtment HousseCommercial E] Trailer Court E] Motel E] Other ❑ Number of living units: .-' __ Number of bedrooms .-/_ Number of baths Lot size __ --- .___ ____ ---- ------•--•--- --• -•-- - Water Supply: Public system Community system ❑ Private epth to Water Table %,C- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No ❑ New Construction: Yes ❑ No Rj--I A/VA: Yes ❑ No ❑ TYPE QF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) 7 eptic Tan Mance from nearest well-________________Distance from foundation-------------------Material----------------------------------------- f No. of compartments-------------------�-----y--size-------- ------------------Liquid dept----------------- ------.-Capacity----------------------- i osal ie dDistance from nearest well_ ]6-r�il_.Distance from foundation____/_Q______-Distance to nearest lot line___,______ Number of lines_____1_____ ____ ______ Length of each line__.�Z3---/_._______.Width of trench.=a_<L-!.f_______.____ Type of filter material_ . C ___Depth of filter material----- �f -Total length------------_____________ �_-- Seepage Pit: Distance to neare t well_ZP4`_�_�__Distance from}foundation-----.-1......Dist rice to nearest lot line-----��_ Number of pits.__.----------------Lining maferial_R—A--A---__-.Size: Diamete r_n .��-----Deptf�-------------------__._._.__ a� Cesspool: Distance from nearest well________________Distance fro k foundation_____--____-__!_-_Lining material____._._._-___.____________._____.___ Size: Diameter------------------- -----------------Depth---------------------------------- - -- -------------Liquid Capacity --gals. a 4 Priv Distance from nearest well-_.____________________ --Distance from nearest building ❑ Distance to nearest lot line-- ------ ------- ---- ------------------------------------------------------------------------------------------ --------------------------- Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------- ---E-- ------ -----------------------------•----------------------------------------------------------------------• ------------------------------------------- ---------- ---------e--------------- -------- - -- ---- -- ------ ----------------------------------------------------------•-------•---------------------------1----------------------------------- ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St te. laws, and rules and regulatio of the San Joaquin Loc i Health District. (Signed)----- --- -------- ------ 4�c� r - ( I ----------------- wn aAderContrac+or] G. 17 ��q }} By:---_---------_-------------------------------`---------------------------- ---- �` /a----- --------(Title)--------------------------------------'--------------------- �k (Plot plan, showing size of lot, location of system in relation wells,.buildings,,etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------------------------------------- DATE----y--k/, -_43 ---- REVIEWED BY-------------------------- ----- -----------r-------------------- - --------------------------------------------------__ DATE------ ------- --------• -----------------------------:------ BUIL ------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------- --- --------------------- --------- ---•----------------•-------------------------------------------=-------•---•--------------------------- ---•-----•---------•------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------••--------------------••-- 1 ---------------I-------------------------------------------------------------------------------------------------------------------------•-------------------------------------------.---------------------------•- ----- ------------------------------------ ... FINAL INSPECTION BY2 ..n -__ ------ Date.. /'._?-G / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 nEVkSED 9-59 3M 3-'63 F.P.Cp.