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FOR OFFICE USE: "^ / __ - Permit No. 7. 5 `rho APPLICATION FOR SANITATION PERMIT 5 q----- ---------- - (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. This application is made in compliance with County Ordinance No. 544. ' G�'1 7 _c-f _ �"-------. -- ------ JOB ADDRESS AND LOCAT ON_J -Zr�-- ---------• F ------ Phone-----------------------•------------ Owner s Name______________ ----------------------------------------------------------------------- Address----- � `fi=r»( ----------------•-------------- Contractor s Name___________ _ _ Apartment House El Commercial ❑ Trailer { our} lvlotel E] Other E]Installation will serve: Residence ❑ p 2 t� _ "' si e . cif -.ey Number of living units: ?--- Number of bedrooms __-___ Number of baths ___t-_ F Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table . Q ft. Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y Previous Application Made: (If yes,date_-..___--.__..__- ) No 0 New Construction: Yes ❑ No FHA/VA: Yes F] 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-----------------Distance from Ifoundation--------------------Material------------------------------------------------- ❑ No. of compartments---- ------- ----------Size------------------------- Liquid depth Capacity. Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line------------.____ ❑ /� =, �.w Number of lines-----------------------------------Length of each line------------------------------Width of trench---------- ------------------------ `G f, Depth of filter material----- length------------------------------------------ Type ----------------------------------------- J T e of filter material____________________ -� Yp p Dist nce to nearest lot line__.'Seepa, P' Distance to nearest well-7? "?L-C___Distance fro fou dation.___ -.--- __.Depth__..--___.._r ------------ Number ----------- Diameter Size: -_.___- ----------- Number of pits_--.____ ---._____Lining material :_ ___- .- ng -- Cesspool: Distance from nearest well_______________-Distance from foundation------------------- Capacity gals. ❑ ----- q p tY Size: Diameter--------------------------------------Depth---------------------- --- --------- ----- � . r Privy: Distance from nearest well------------------------------------------------Distance from nearest building___.--__________-_____________________. ❑ ascribe :- ----- .�- "/ ----- -------- ------- ----------- ------------------------ •- -------------------------------------------------- E r Distance to nearest of ine_____________ Remodeling and/or repairing (d } >!i�-- - G' ---------------------------- -------------- ----------------------------------- ---------------------------------------------------------------------------------•---------------------------------------------------_-------------------------------------------------------------------------------------------------____ 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. °" i` ____(Ow r and/or Contractor) (Signed)----------------------- BY=-----------•---------- y`J_ " — - ----------------(Title)------------------ -- ---- ---- --- --- ---- --------- (Plot plan, showing size of lot, location of s em in relJition to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s APP!_ICATION ACCEPTED BY-------------- �'----- ------------------------------------ --------------- DATE---- �-"-�--•------ -•----- ------------ ��-- REVIEWED BY----------------------------------------------- ----------------------------- ------------- -----.. DATE--------------------------------------------------•--------- 4 __ � DATE------- ----------- ---------------------------- BUILDING - -- ---------------------- BUILDING PERMIT ISSUED---------------------------------- �- � -•s--�=.�_.�-�-F•.._. @ ..._ L� / i Gee— s: ./= J ` ----- Alt`� tion and/or,recommend anon ` ------------------------------------------------------------------------- ---------------------- -------------------------------------------- ---- CX-7'00 late `f . .._ ------------- / � Q ---------- ----------- -- ----- FINAL INSPECTION BY: ................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ffa:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracyr California Epi 9 REVISED a-5g 3M 3-'63 F,P.CC.