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FOR OFFICE USE: 9 H w-------- -Il;-7u-------- ; APPLICATION FOR SANITATION PERMIT Permit No. ... . ------------------------------ ------------- ------------ (Complete in Duplicate) / C� This Permit Expires_1 Year From Date Issued� Date Issued : ___':/__- _ / 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 o. 49. JOB ADDRESS D LOC ION _ _.I_ ^' -- --- - " " "-- " ------------------------ ----- -------- Owner's Name.. A�s ----•• 4 . -----•------ - ------- ------ Phone�+6 �'._1� n dress................ ._2—...1X: .x---- - ------------ ---.--------------- ------- - Co _ _ ` �-_ _ ' --- ------------------------------------------ ----------- Contractor's Name___--- �_-. -•-- f_-- — __ Phone--- Installation will serve: Residence ❑! Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -V'—.N mber of bedrooms __`--Number of baths __�ot size .._Z �___�__�_ ._ __y_______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ` _451t. Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe 2--Hardpan El Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes ❑ No HA/VA.. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ic'T 1 Distance from nearest well________________Distance from foundation------------------- Material____._______________________-.____-____.___._- 1 No. of compartments--------------------------Size-------•-------------------- --•Liquid depth--------- --------Capacity----------------------- ' P D' os eE Distance from nearest well _ Q_ i9-Distance from foundation-...0_/_......Distance to nearest lot line_____ Number of lines ----- ,---__ _ _ Length of each linQ �_�_.Widfh..of trench---, . _,-____---- �� ... Type.of filter material eptRef11ria____:._J_1_ _______Total length___________________ 0_____._ e _[__e3 ___ _____.Distance to nearest lot line___ s� 00 I istance to nearest well_1�jD_ ist ation_____Number of pits._` _________________Lining mat riSize: Diameter__ 'r'__..De th_____�/_�'_______.____Cesspool: Distance from nearest well_ _______________Disation-_______--_____.--_lining material._.._______.____________________. ❑ Size: Diameter--- ----------------- ----- -----Depth--------------------------------- ------------------Liquid Capacity- ------------------'_._._"gals. a Privy: Distance from nearest well___ _________________________Distance from nearest building.__._._.__________________-____________._- r ❑ Distance to nearest lot line------------------- - ------------------------------------------------ ------------ -------- ------------------------------------------------ Remodeling ------------------------------------- --------Remodeling and/or repairing (describe): - -- 4 ---••------------ -- ----- -- 0 --- - --- -- - ---- - -- - - ------------------•-------------•--------------------------- ---------------------- -------- -••- - -------------------------------------------------------------- ------------------------------------------------------------------------------------------ ---------------------- ---------- --------------- I hereby certify that I have pre6red this application and that the work will be done in accordance with San Joaquin County i ordinances, S+ la s, and ru s and regulations of +he San Joaquin Local . ealth District. (Signed) ' ` - flJ.� _0 �---- Alt— �"-------- --._.( Contractor) By: r / (r+le) -------------- ' -------- ------------------------ - (Plot plan, showing size of lot, location of system in re fion to wells, buildin , etc., can be placed on re{verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- 7 ------------ - -----` "y �------------------------------ DATE--------9- -------- ---- ----- f' . REVIEWEDBY------------------------------------(------=---------------------------------- ------------------------------------------ DATE...a BUILDING PERMIT ISSUED---------------f---------------------- = DATE - - ----------------- ---------- Alterati ns and/or recommendations:_______ .._ ��' _____ ":__ -��- --------- -=t_= �r2, � ` � = ; -------------------------- ----------••------------ ---•------ f ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ t FINAL INSPECTION BY:-------- ------ _ _- / �/ y ----------------�------------ Date----------------------------- ----- ------------------------------------------ S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street- 205 West 9Th Street Stockton,California Lodir California Manteca,California Trocy,California ES 9 REVISED 5-59 3M 3-•63 F.R.CIl.