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FOR,.OFFICE USE: ^ ---- -- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....�1Gc.. .. ... ------ -- ------- ------------------- --------------- -- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.es-e This application is made in compliance with County Ordinance No. 549. � _ f JOB ADDRESS AND LOCATION---: �}N_ C --.----- -----��r�--------------F13-- -c�_N-0------------------------ Owner's Name--- - -----------------------------------------k Phone---------------.._------------••---- Address----------- = 84?x--------13 ------------------r t---------------------------- ---•--•--------------------- Contractor's Name_ 1 4- ---------------------- ---- Phone Installation will serve: '. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _____ Number of bedrooms ---✓- Number of baths __t___ Lot size _...�i-©----A.C_ i_Ea--_"---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table' 147 JX ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application- Made: (If yes date______________+_._.) No gr. New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted-if-public sewer is-available within 200-feet,) Septic Tank: Distance from nearest well_--661P_ __Distance from foundation----hQ----------Materiai----��h=--fit�'�1�'D.^________- P 0' No. of compartments-_____.'�___._.__Size-_�.,4_._�1p-X\__��___�__Liquid depth----� ---------------Capacity-./Qq� Disposal Field: Distance from nearest well-_ '--.-Distance from foundation---- 0---------Distance to nearest lot line--15— Number of lines 7 R..rl3�-P___-Length of each line-----------------" _ ____________Width of trench.."'.._ .. ----- Type of filter material_4.3v_c4t _:__Depth of filter material-_17-11------_Total length-.------- 7- ---17-_ Seepage.Pifi: # Distarsc6-to ne restkwell___ --------------Distance from foundation.-....-------------.Distance to nearest lot line----------------- 4y ❑ Numberof pits----- sem`-'Lining material-----------------------Size: .Diameter----------------------.Depth--------------------------------- Cesspool: ------------------ --_---Cesspool: Distance from nearest well-----------------Distance from foundation----------------- material-._.___----___-_.__-_-_:____--_-. ❑ Size: Diameter--- =x Depth_ Liquid Capacity-- ----------------------gals, Privy: Distance from(nearestwell___---------------------------------------------Distance from nearest building-t_____f_-_---_--------------- ..------- - ❑ Distance to nearest lot line------------------------ -------- -- --- -->=---------------- Remodeling and/or repairing {describe):-------\1JVE:W------ -t_N L_T �_____�.? � ___. �.R1I—A - _____� Z)1__r�-r- AF__ �--`-------------VF)_ .Tr fmM_—------------------------ �X-1Sl_/-�f_C� ---Fad 'p1R7C- of-----IX5_ 4c--- ---*-_(_f>- ----------------------------------------------------------{�..---------------------------.-----------------------------------------------I------------------------------------------------------------------------- - I hereby certify that I have prepared this application`Ad 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)----- --------------------------------------------------------------------------------------------------- --------(Owner and/or Contractor) B . - R�. . - Title--.: �._,:: =, .__:.----- -------------- (Piot plan, showing si . lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_:.` [_ _a ._:--------------------------------------------------------------------- DATE------!__�-�-�'�`-�-�---------------- REVIEWED - -- --- REVIEWEDBY-------------- --------------- -------------- ---------------------------------•--•---------- -------------------------------- DATE--------------------------------------------- ------....... BUILDING ------------------------------ --- ---- - BUILDING PERMIT ISSUED---------------------------------- -i-------------- DATE----------------------------- Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------•----- -•--•------------•-•---------------------------- ----------------------- ------- - ---------------•------•-------_--------------------------------------- --------------------------- --------- -------- -------------------------•-------••- ----------- ----------------------------------------------------------- ---- ------------ --------------------y -----•----------- ------------ --- ---------'----------- ............. ----C _.'--i FINAL INSPE - --- --------- ------ ---- -- ------------- Date_ 1_GY / -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California CS 9 REVISED 6-S9 3M 3-'63 F.P.E . i