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rux uiI ust: .- -_. APPLICATION FOR SAINITATION PERMIT Permit-No.—JL.Z. 3. 7 ------ ------------ ----------------------------------- (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued ---------------------------------- ----- --- Date issued .__.�__'l`. _1' � Application is hereby made to the San Joaquin Local Health Districf for a permit to construct and install the work herein described. This application is made in compliance withCountyCounty Ordinance No. 549. JOB ADDRESS AND LOCATION------- l5---------_/ � V11_ _ _.__-___"_____.____""- f Phone_ / Owner's' Name------------ ----------- 1.E' --- 7 Address-.----= - = ---------- ., - ------- - ---•------------------------------------------------------------- - Contractor's Nama. f ---------- ' - -------•-----------------•----' Phone---. ..__._ -�� Installation will serve:, Residence Apartment House ❑ Comr!at ❑ Trailer Court [] Motel ❑ Other Number of living units: ___.____ Number of bedrooms C" Numser of baths 4� ❑ I ' Lot size ----------- ..... '5-�---------- Water Supply: 'Public system•K -Community system stem t ❑ Private � Depth to Water Table -------- ft. Character 6f — ,soil to a depth of 3 feet: Sand ❑ Gravel,❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J' Hardpan ❑ ' -` Previous Application Made: Ilf yes,date____-_.__.___....:.} No [�' New Construction; Yes ❑ No'❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No sepfican I r cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: Distance from nearest welt_-41-J------Distance from _ foundation__________________ Materia ------------------------- 171 No. of,.compartments-------------------- Size-----------------------•--------Liquid de th-- ------------ ---------Capacity------------- Disposal Fed: o - D�sfa n ,frm nearest well from foundation--------------------Distance �1r to nearest lot line_________________ d ❑ Type u bof fii#er material___-- ---- "---.-Length of each line------------------------------Width oftrench--------------------------- i Depth of filter material----------------------- Total length---------------------------------------- Seepage ---------------- ----Seepage Pit: Distance to nearest well._/ C?------Distance from foundation-------------: Distance to nearest lot line_________________ i Number of pits---....... ____.___Lining material----------_------------Size. Diameter__.__-4_ �� 1 Depth _?�------------- Cesspool: Distance from nea est well_________________Distance from foundation._._________.____ Lmmg material---------- _ Ej Size: Diameter_ ' ------------------------Depth------------------------------ -------- - 1-----Li Liquid Capacity I q P Y -----------gals. Privy; Distance-from nearest well__-._______ ____________.-___-_-____ __ Distance from rnearest buiidin g , . ❑ Distance to nearest lot line_._._____ • i Remodeling and/oi epairing,(describe --------------------- - F - "-----------•------------------------------------------------------- ------- ' ----------------------------------------------- ----------------------------------------------------------------------•---------------- -------------------------------•------------------------- 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' d rules and regulation of fhe`,San Joaquin Local Health District. (signed) ---- --- ---- --------- f 1 ----- --------------------- --------------------------------=---------------------------------- ( and/or Contractor) By:. " •----•-------------------- Title ----------------- --- -- ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can I;e placed on reverse side). ----- - ----------- i FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----------- __ -__--rk_ ..---'_. - DATE - - i REVIEWED BY----- - ""_ _ Y -�. . tom..:. — w --,---.,---DATE - -- --------------------------------- - - - - ------------------, ---- 'DATE-- UILDING PERMIT ISSUED--------------------------------------------- -- - - - --------------------------------------------------------- -- - ------------------------ ------------- --------- DATEAlterations and/or r cmmendtons _ ------------ - ______ __ �_..x94-____ T -------------------------------_---------------------------------------------------------_.____._.__-___._.____.._._____ f FINAL INSPECTION BY:.-----llrp,_._.-_6(w. -4 ._ / _ ------- Date----------------------- �r SAN JOAQUIN LOCAL HEALTH DISTRICT I i f 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cit.