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FOR OFFICE USE; ---------------------•---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _---_- --_- 9 ----------------- ------------------ -------------------- (Complete in Duplicate) Date Issued -----------___-------------------------_------------------ This Permit Expires 1 Year From Date Issued I i 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 complianceiwith County Ordinance No. e� /fy.;,a�s r7oA7 77{_��e� �D _ JOB AEj,DRESS AND LOCATION__D '7 .L -1 'SIC � ----------------/' * -----�N-----/VQ/ T/f-----r�IPC�V -R'c>`- ------------ ) . Owner's Name-------•--�(� �- - k-_ !.... Phone: e _1/__77l_..--- Address--------------------- f "•-•--------------•------------------------------------------•-••------------ ---- -- -------------------------•---------------- Contractor's Name__€ -------�_/.i'h'_/_ f_ --------1 �� { T ___ Phone. ' �"_�1 Installation will serve Residence Apartment House ❑ Commercial ❑ Trailer CourO[j Motel ❑, Other ❑ 3 ' Number of living units:-_-J_l Number of bedrooms:Z-_ Number of baths.__ Lot size ........66_____t?_ f___S____________________ Water Supply: Publidsystem ❑ Community system ❑ Private Dd Depth t)Water Table ft. Character of soil to a depth of 3 feet: , Sand ❑ Gravel ❑ Sandy Loam Ig Clay Loam:❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- ........) No New Construction: Yes ❑ ,No FHA/VA: Yes ❑ NoXI TYPE OF INSTALLATION AND SPECIFICATIONS: - ._. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic T aDk.,,f,q6.Distance from'nearest well_________________Distance from foundation---------------------Material------------------------------------------------- No. ___---_------_--_-_________._.__._._---.___.No. of compartments------------- ----------- Size--------------------------------Liquid depth*------------- - ---------Capacity----------------------- t / -r Disposal Field: N Distance from nearest well.__Qro____ Distance from foundation.-_.....A 4____-.Distance to nearest lot line__„s_n.___ r5J Number of links----------1----------------------Length of each line-------- __t'1AV___.___f;--.Width of french---------`�`�------------""-- G A D Type of filter material__ � -Depth of filter material--------- �______Total length_____________________4:10--1------ Seepage Pit: Distance to nearest well________________ -_-Distance from foundation__:.___.----.-------Distance.to nearest lot line----------------- ❑ N�m't jr' of pits.--.---�-----------Lining material----------------t ---Size: Diameter-----------------------Depth--------------------------------- % Cesspool: Distance from nearest well from fou l- ndation_" ---------------- Lining,material---:--------------------------------- . 1%El :.Size. Diameter------ --------}--- ---------------De th----------------------------------------------------Liquid Capacity --gals. �. Priv Distance from nearesf well- -----------------_____----___-___.-__._--_Distance from nearest buildin Y= 9 4 ❑ Distance to nearest lot line---_1_1---------------- ------------------------------------------------------------------ ------------ -----------•--------------- ----- f _ Remodeling and/or repairing (describe):____----__ ./�.0_______TV--------A?Sl_5!//VC----- -S ------------------ -----------------------------------------------------------� ------------------------------------------------------ ------ ------------------------------------------------------------- ------------ - f ! ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- i 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)---.------1----------� - -- c-'S---------------- 1!�� _ -._ er and/or Contractor) --------------------- ----------------------- _ CSC. ”` (Title)---------- ---------------------- --- - - - BY•---------------- - t ) Plof len, showin slze of lot' location of s st in relation to wells, buildin s, etc., can be."la6ed ori r'e`verse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ---------------------------------------------------------------------------_------ DATE---(---- �- w REVIEWED BY - --------------- �` ----=----- DATE----------------------------------------------------•---- BUILDING PER{MIT ISSUED----------------------------------------------------) - -------------- L--------------I-- DATE-------------------'I - Alterations and%or recommendations:__t-'--------------------------------- ~' i 1 ! 4 ---------------------------------------------------------------------------------------------------------- ° I I -,.�'... rw �. - ..>-A.....�•a-s....._.-_d.�-+.w.w..r FINAL INSPECTI�O`N—BY - sQ - ---= -- Date / (� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED &-59 3M 3-'63 F.P.CD.