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r.� FOR'OFFICE USE: �- ----------- - ------------ ------------------------- i APPLICATION FOR SANITATION PERMIT Permit No. ___�_..... . . {Complete in Duplicate) 1 / 3 --------- : .- ------- Date Issued €� -------_-- ___________________ This Permit Expires 1 Year From Date Issued -p05 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. mF)NrrE<P- ` � JOB ADDRESS-A D LOCATIONC Owner's Name •M-c y tv_!.-�--I�}------------------------------------- - - ---------------------------------------- Phone.----------------------------••---- A'ddress � __- r� - ------------------------------------ El Contractor's Name-------0_W___N_ ------------------------------------------------------------------------•------ Phone-------.--------_-------------_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other: ❑ - --------- - -- Number of living units: _1.----.Number of bedrooms ________ Number of baths _ .___ Lot size _._.__ Water Supply: Public system ElCommunity sy em ElPrivate Depth to Water Table --- ft. ` ® X/2 a Character of soil to a depth of 3 feet: Sand Gravel ❑ San Loam El Clay Loam El Clay El Adobe[]� Hardpan ❑ . Pr€ evious Application Made: (if yes,date--------------------I No JZNew Construction: Yes No ❑ FHA/VA: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: I (No'septic tank-or cesspool-`permitted if public sewer is-,available within'200 feet.) from foundatlon____ --------------- S epti Distance from nearest well--_50----- Distance - No. of compartments_--__- .__ ___------Size______.x -----------------Liquid depth_-- '�Lo nearest lot I€r p _______ T Disposal Field: Distance from nearest welli ......Disfan a from fcundat€on.__�� I � �� I' Number of lines..______ _.... -__.-__.-_Length of each lin - r-�-__.__.Width of#Tench_________ __. line_d ------- l __Disponee � ,r of filter materlal_ Q� ,______De th of filter mater€al___ __ ____________._Total length.___-__._.___--:_ g _------ Type -- . Seepage Pit. Distance to nearest well---------------------- 'from foundation___________________.Distance to nearest lot'.line__.__._-____---_.11 �p ❑ Number of pits----------------------Lining material--------_--------------Size: Diameter------------------.___..Depth-------1_�l----------------------`„ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------ It I ❑ Size: Diameter--------------------------------------Depth---------------------- -------------------------.Liquid Capacity--------- '...gals. 1 Privy: w . Distance from .nearest well________________ _.._ ---___-______--___--_..-Distance from nearest building.__-___----___-___________.___.__-_.-. Gh ❑ Distance to nearest lot line-------- ----------/----------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------- ---------------- -------------- * y l f . w -�• ---- I1 �: '1 ' - ----- ' = ---- - ---------- ---------- -------- -- �€Y" I hereby certify that,l have,_prepa eol„this appl€cation and that-the work will be done in accordance with San Joaquin County ordinances, State la4s, and rules and regula r ns'o'f,the San Joaquin Local Health District.?, ---- ----- -- -------` ' --------------- (SignedF - caner a kk r Co (O and/or ntractor] 4 _.,,;,�y: .�.�., _,t.,. .--- _----- -s- � -- --=s;�---- g ,,,, �a{bele) = d` 4 (Plot plan, shoeing size of_:lot, location.of.system in rela'fion to wells, buildings, etc., c n place on reverse side). r FOR 6EPARTMENT USE ONLY t APPLICATION ACCEPTED BY-----Ti&_ r._.._- )!IA--------------I-------------------------------------- DATE-------h% /7 �------------- REVIEWED BY------------=-------------------------------- ---------------------------------------------------- -_ DATE =----------------------- . :�. .._- ;-- ---- BUILDING PERMIT ISSUED-------------------------- --; `. -- - - --------�<--- --„�- DATE------------------------------ , . Alterationsand/or recommendations----------- ---------------------- -------------------------------------------- ------•-----------------•------------------------------------ -------- Il . ----------------- - ------------------------------------------------------------- --------- ----------------------`------------------------ - -- - A � , r ---------------------- ------------------------- ------ ----- ------------- -.--�::-------- 114 l 1 •: f 1 FINAL INSPECTION. Y: - Date- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street y Stockton,California Lodi,California Manteca,California Tracy,California F € E5 9 REVISED 8-59 3M 3-'63 F.P.CO.