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FOR OFFICE USE: L --°-------- .. ------------- "' C ----- APPLICATION FOR SANITATION PERMIT Permit No. .l- F. t--•-- ------:--- (Complete in Duplicate) 3/ -- ---- ---------- ------------ ----- ----- - � �Date"Issued This Permit Ex ices 1 Year From Date Issued i Application is hereby made to the San Joaquin Local•Heallfh.District fora permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. J JOB ADDRESS AND LOCATION. /�r�� '� --�-3 ------ 2............. ...` Owner's Name--1-49.4m, •- ---------------- I Phone GAddress------�-'r --- ------•------------------------------------- Phone... Contractor's Name_ 7 I Phone...------------------------------.. ... p -------- _ - II - Installation will serve: �Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.¢__ Number of bedrooms�_.?___,Number of baths a 41-ot,size _ _._ -- -�---------- ------------ Water Supply: Public system [-Inmmuriity system ElPrivate ❑ Depth to Water Table ,[eft. ! Character of soil to a depth of 3 feet: Sand ❑ Gravel"❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeitr pan ❑ Previous Application Made: (If yes,date-----------,--------) No [R�New Construe+ion: Yes to ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public.sewer-is available within 200 feet.) r _-------- i ---- �No. of compartment ___.____Size__ .- ?ezo Luide fh.__ .Ca acitY .�.� Disposal Field: Distance from nearest well-- Distance from foundation.-1-6--#--------- to nearest.lot lines___---...- ir Number of lines____'._- ------------Length of each line__�L ---/�6Q�.��Width offrench.--Z---.f-------------------------- Type.of.filter Material b" - _____Depof filter.-material__�,�'__________. length Total len fp-'`---------- eF -th + Seepage Pit: Distance tnearest well___r_ __._.___;Distance from foundation___/4t__-_.___.Distance t� nearest line.l _____-.-. Number of pits-----.w -------------Lining materiaSize: Dlameter_. _ _�_- - p p�.- ------------------ { Cesspool: Distance from nearest well_______________fbistance from foundation--------------__.__.Lining material-------- --------------------------- 4 ______________-_---______ € `' -------------- - Liquid Capacity--- -�------- s l ❑ Size: Diameter-------------------------------------=Depth # gals. Privy: Distance from.nearest well--------------- "1---"---_.-----------------__...Distance.from nearest building.'_"-- .--;----------------------------- --- _'-- ------------------------------------------ Remodeling - -------------------------- ❑ Distance to nearest lot line------ -----�€-------- -----•---------- - -------------•----------•---------------------------� --:--- -- Remodeling and/or repairing (describe)=-- ---------- -----------------•--•--------•----------------------------------------------------- -------------------•-- ----------------------------- pp. 1 R ------- -------------------------- '- ------------------------------------------------------------------------------------ '-----.r-----•"""""•-•-------------------'-------^._--•---'----- k I hereby certify + i I ------------------------------------------------------------------ + hat 1 have prepared this application and thaf the work will be- done`in accordance with San Joaquin County ` ordinances, State laws, gpd.rul,es a regulations of the Sart Joaquin Local Health District, a `` "► i� 'S e k ---(Owner and/or'Contractor) (Signed) - - -----------------------Title---------------------------------°------------------------------------------ - ---------------------•----- -----------• fq-w { ) (Plot plan, showing size of lot,.location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY ---it------ - ------------ DATE l . APPLICATION ACCEPTED BY-- i DATE REVIEWEDBY------------------------------------ ------- ---- ----------------------- --------------------------------- ----- ------------------------------------•------------ ! BUILDWG PERMIT ISSUED --------------- DATE Alterations and/or recommendations:_____• ter' �F�.- --------- � "- s -_ '.- �t � --------- __ _ v f _ ----- ------------------ •------- ------------------------------ ----------------------------------------- --------- -------- i ---------------- --------------------- -------------------------------------------------• •- ----- i -•-------------------------------- ----- R ___`-----------------------------------'- -----'-' s I� 1� FINAL INSPECTION BY:.-- 1!/.._/� - Date+ ~--r--/.--+ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 6 i F° 1601 E.Ha=elton Ave 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Califora� Manteca,California Tracy,California I ES 9 REVISED 8-59 3M 3-'63 F.P•C13. ' I�