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FOR OFFICE USE: i - --------------------------------------------- ------------ .,_ - � j� -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..,1.... ----------------- ---------------- -------------------- (Complete in Duplicate) Date Issued1-!�/�._7 ------------------___.__.__.____.__..__._-_. ----- ___ This Permit Expires i Year From Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appliceton isade,.in compliancewithCounty Ordinance No. 549. r sen/, JOB ADD RESS'AlVW'LO'CP.TION__.- -Al_--IT -------RL?_...___�------ Owner's Name ----------------&-L-.---_---ScH_u1!!.1.Gate,---A----------- --------------------------------------.... Phone.................................... I Address-------------- ---------------- -:P"0.5-----13cu----:_43.7-/........ = ------------------------------- Contractor's Name----------15 *9tt,f r'.t ` "" r F.. -•_--- - ---- --- Phone-------------'-------------------- Installation will serve: ;Residence ❑ Apartment Hlouse ❑ Commercial ❑ Trailer (Er""Motel ❑ Ofher ❑ Number of living units:'.--/---- Number-of-bedioorns_./C41\lumber of baths j___ Lot sizef?. _______________ _ ll Water Supply: Public.systerri E] Community system [-] Private epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam Clay ❑ Adobe ❑ ' Hardpan 0____ Previous Application Made: (If yes,date---------____ F' __1 No [Z/New Construction: Yes 0--No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �:![No septicjank.or cesspool permitted-if public.sewer is ayaila6le_within::200.:fee+.} � ,_ .. �--��- �•�- .�-. Septic" ..ank:- '"'^—Distance'from•nearest'well__,--,5 ______Distanc •from'foundation^��_____-------Material- ��1_:�._._____. � IffNo. of compartments____.._._ y � .Liquid depth___ , Capacity:__ �� Size.. Disposal Field: Disfance from nearest well-3-0----- from foundation____10--------- to nearest lot line------S_ Number of lines---- ___. Length of each line________ f�----- ---------Width of trench--------`- __________________ Type of filter material---RCQS-J<___Depth of filter material______/ --_k______Total length____________________ Seepage Pit: Distance to-nearest well--------5Q______Distance from foundation----AO........Distancerto nearest lot line__.----- - --- Number of pitsi_____ _________ _ Lining material__ "_QG -i_.Size: Diameter-_ __ X _Depth__.._ ----------- Cesspool: Distance from nearest well ___ _Distance-from foundation Lining m'aterlal__-- -" F1Size. Diameter!------------------------""=r^ :Depth -* �- ► '`-------- -----------------Liquid capacity-_------------------------gals. I } Privy: Distance from nearest,well-------__________ ___"_-_"-_____,_____.,_.__.__.__Distance from.nearest bui dIngi-_________________.-'________________- 0 ❑ Distance to nearest lot line-------------------- --------------- ---------------------•--•- �' ------- ' Remodeling and/or repairing (describe) - - ---------•-••- ------- - '----------------- --------------------•--•----------------------------------- ' k .- -------------• --------------------------------;--------------- - +�--- ---------------------- - ________________________________A__..__.______ ___..___________.____________" ._ _______________ yj { I hereby certify that I Ila a prepared this applic*a'#ion*andp-th�at:,the-work-will=be done-in-accordance,with San Joaquin County ordinances, Stat laws,,,and roes and regulations of the-&n_Jpequin•Local=Health,District.t `r.•+"" c.Xj�%/---------------------------------------------�-------------------------------------------------------------- (Signed)------ ---- ,: (Owner and/or Contractor) BY ------ ----------------:----------------- ---- ---- ------------------ ------------- ------(Title) _ -- ------ -- �f_sy -,-Y � -_-P_--_ "6n:=' - -- " -d+r- (Plot plan, showing size of Io#,.Inca#ion of system in relation to wells, buildings, etc.,_can be placed on reverse side[. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---------------------------------------------------------------- DATE REVIEWEDBY---------------------------------------------I- ---------------------------------------------- -------- ---------------- DATE------------ ----- - -----------=---------------------- BUILDING PERMIT ISSUED`___r!""7--" r .. .,..,-_ AE#era#ions and/or recommendations: . , -----------------------------------------�w�- '; ?'-----s° __ V' --------------------------- --------------------------•-- - ------------------- ----- -- ---------------------------------------------•------------------- - _ �-- � _ FINAL WSPEC BY ,r Date --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9.59 31A 3-'63 F.P.CO.