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FOR OFFICE USE: -------------------- --------------- ____.__._..__-1; .---. APPLICATION FOR SANITATION PERMIT Permit No. ------- (CSmple+C in Duplicafel 4---------- ---------- This Permit Upires 1 Year From Date Issued Date Issued-31-74- =�%5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafir.,-n is.ma-de in compliance with County Ordinance No. 549. JOB ADDRESS AND L, CATIONJ ----------- ...... Owner's Name--------- - ------------- --------- - ----------------------------------- Phone----------------------------------- Address------------------- ---42e� - --------------------------------- Contractor's -----(�2 ------ Phonej3-'�; Installation will serve: Residence zn Apartment House E] Commercial E� Traill, Court El Motel E3 Other'�E] Number of living units: Number of bedrooms ------QNumber of baths ........ Lot size ---(c- / - - -------------------------------- Water Supply: Public system El Community system El Private K?"6epth to Water Table ft. -i-- Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam F] Cla-y Loam El Clay E] Adobe ��arclpan ❑ Previous Application Made: (If yes,date-----------7--------) No DI-*"New Construct;o.n-,-. Yes 53,' No 0 FHA/VA: Yes [j No Fr--� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p6miffed if public sewer is available within 200...feet.) Septic Tank: Distance from nearest well---$-t') _____ Distance from founclai�on-'---/A---------Material No. of comparfr6nts----X--.. ...... ------- ------------ -------------- ---Liquid depth----!K4Z- ---------Capacity-i------------:otA Disposal Field: Distance from nearest well .__-__Distance from founda4o Distance to nearest lot line-- ---------- ' )---J0 R '',,/ ---- --- -----Width of trench.- c;1 op Number of lines----------CP -------Length of each line --------------------------- Type of filter materia �- .4Z-A0QAPepth of filter material------ ------- ----Total length------ Seeps Pit: Distance to nearest well__.-- -._----Distance----Disfanfe from jqundation�'-'/-4�--'Y---- Distance;o nearest lot line__.______.._ 1Y Number of pifs.-I-----/-----------Lining material—A_0_<_---Size: R1MWer--4X- 4.2.--_-Depth------. _--------- ---- Cesspool• Distance from nearest well_________________Distance from foundation___._...-- ---- ---.1ining material___.__._.._.....____---__._.____.__.. Size: Diameter--------------- - -------------------Depth------- ------------------------ -- ----------------Liquid Capacity----------------------------gals. Privy: Distancefrom nearest well---------- --------------------------------- ----Distanc4frorn nearest building__________.__.-_----.____________....__._. ❑ Distance uilding---------------------------- ------------- Distance to nearest lot line t Remoclelig and/orrepairing (describe):_--_- --- t,—ZZI- �v4l' -1-------------- ------------- -�Pw A a - ------- - ---- -- --- -------- ----- ---------- -------------------------------- -- ............. ----------I- ------- ----------------------------- ------------------------------------------------------------------- I------------------------------------------------------------------I------------ --- --- - --- ----- - I hereby certify that I have prepared this application and that'-f-he--wor-Ilk will be done in accordance with San Joaquin County 0 ordinances, State laws, and rules an regulations off th.. San Joaquin Local Health District. 3 (Signed)------ --- ----/-- 0--- - -- --- ---- ---------------- --------------------- ---------------------------------------------( wner and/or Contractor) By:--------------------------------------------------------------------------------------------------------- -------------------------(Title}---------...------- (Plot plan, showing size of lot, locati( ------------ ------------ ;n of system in relation to wells,,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________ ------------------------------ ----------------------------------------- DATE.....��= 1-44- --------- ----' ------ --- ---------- -- -- REVIEWED BY --------- - ----------------------------- ------j--------------------------------- DATE----------- BUILDING PERMIT ISSUED------------- ------------------- -------------------------------------------- DATE Alterations and/or recommendations:,------------- ------------------- ....... --- ----- ----- --------------------------------------------------------- -T-A-dj- . '- -------*------------ ------ ----------------------- ----------4 ---------------------------- -------------- ------ ---- -- - ---- ----------4----- - --------------- 141 ad---- ---OG ----------- - ------ ----------- -- ------- --- ------ - ---- -------- .............--------------- ------ Date --------------------------- ----------- SAN JOAQUIN.LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California TraCYr California