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FOR OFFICEUSE: . y s ----------------------- _- -_ __-__-- APPLICATION FOR SANITATION PERMIT Permit-No. _V./17 _ _.... '----------------- ----------- r _ (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. 549. ' ; JOB ADDRESS ANB�D� LLO/O'CAQ/TIION/ (_� �j� :_�_ --- ----------- Owner's Name__ l ------ - • - - - - =--------------------------- -- --- --------------------------------------------- Phone------------------------------------ Address------ _--•-------------------------••----Address------ -- --------- Phone 59 Contractor s Name______ .... _ y = Installation will serve: Residence Apartment'House ❑Commercial E] TrailsrzCourt ❑ Motel L] Other E] Number of living units: /------ Number of bedrooms __off__ Number of baths v-7-__•Lot size --- _____________________________________________ Water Supply: Public system ❑ Community system ❑ Private,0 Depth to Water Table-4A ft. Character of soil to a depth of ifeet: Sand ❑ Gravel ❑ Sandy Loam El - Clay Laam [3Clay,❑- Adobe§d Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No X 1=HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) p S tic Tank: Distance from nearest well________________Distance from foundation-------------------.Material------------------------------------------------- _ � No. of compartments------------------------ Size--------------------- ---Liquid depth--------------------=- Capacity----------------------- Disposal -'--------- ------Disposal Field: Distance from nearest welL.674--------Distance from foundation__s2 d_______.Distance to nearest lot line_/D_______ Number of lines_-___--/_________ Length of each line___ 4 �� [�— _ -------•---- 9 /-j ----------------�Width of trench.--------P�-'��----:-------------- ----------- --�-------- De th,of filter matenal__/1-__________.Total 'length ?_.______ T e of filter material,. - ., _ p g __ — ------- Type - SeepagePit: Distance to nearest welL�_d�_ rpistancom f4und�Ze ni dQ__'_.Distance to nearest lot line_. _sp_�___ (� Number of its____ _____Linin material_ ter......33jt 1Depth----.--A5_`______________ Cesspool: Distance from nearest well--------_--------Distance from foundation-------------------Lining.material------,__._..___._..__._______--_-. ❑ Size: Diameter------='------------------ ----------Deoth_-:-------------------__----=-•-•- ----------------Liquid Capacity-------.--------------------gals. e Privy_ Distance from nea:rest.well_______------____--------______.___:__-_____i_...Distance from nearest building-------------------------------- - ._._ ._._. ❑ Distance to nearest lot line -------------------------- -------------------------------------- ---------------- ------- At Remodeling and/or repairing (describe): -------------------------- -------------------------------------------------------- ------ '! ---- -------------------------------------- ------------------------------------------------------------ -----•------- ----------------------------_------------------------------------•=-------------------- ------------------ -- -------------------------------------------------•----------------------------------------------- --••---• -------------•---------------------------------------•------------•--•-- -------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordi ante$, to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- ----• ------ . ---- - (Owner and/or Contractor) Wil.- - � Plot Ian, showing size of lot, location:of system in relatio wells,.build in s;'etc.,_can be laced on reverse Y• (Title)-.4 [ p 9 Y 9 P side).- . { FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY---- - - ----------------- DATE-- ' 7 REVIEWEDBY-------------------------------- -------- ----------- ----- ---- ------------ ------ DATE------------------- BUILDING PERMIT ISSUED-------------------------------------- 4 - PATE-----. _---------- ----------------------- ---•------ `- ______.. :_ _ _ - _Alteratians and/or recommendations:_ ^_ _ � ___ ` _______ ___---__-- ---- -- '�•�=�----- ------- ` ------------------------------------------------------------------ ---------------------------------------s ---------- -----! -----•--- -----•-----------------------------•-----------------------------=---------------------------=----------------------------- ----------------------------------------------------------------------------------------- S .. 9 FINAL INSPECTION BY:_._��.__-•---rANJOAQUIN------- -------__-_-- Date----�_Jl _!. f LOCAL HEALTH DISTRICT 1601 E-Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.F.CD. l . i