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FOR OFFICE USE: v --------------------------------------------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..1... 13 . --------- -- -------------------------------------- (Complete in Duplicate) ------------------ This Permit Ex ices 1 Year From Date Issued ©ate 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 AND LOCATION--------- -�� ------------ ' h7�Q"� ------------------•----------•-•----- Owner's Name-------- --•----_-Bii,gja-lp Address----------------- --a,2-A---------��! © �5-CAIo/►/ -----------------------:--------------------------------------------------------............ Contractor's Name---- C �Qle----- U!Y:. .--__!___1 - ---" '47'P ------------------------ Phone__ . Installation will serve: Residence [0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _1____ Number of baths _/____ Lot size ________ L' "- -,C� _�___________________ Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table _4776ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa 'Loam Q Clay Loam ❑ Clay ❑ Adobe ❑ ;7NO anj] Previous Application Made: (If yes,date____________________) No New Construction: Yes ® No E] FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 f (No-septic-tank or cesspool permitted-if public sewer is available_within 200_feet. Se t'c ank: Distance from nearest well from foundation_ _l e-_ _ Sep - ---------MateriI--_ ----------- No. ------- - � No. of compartments_______ ----------Size_3_K_'7___X_5_Liquid depth_-Vistnl ' �.�.---Capacity--��-�. Disposal F- 1d: Distance from nearest well. �.�-._.Distance from foundation___-_ _.�___�_---. to nearest lot line____ _________ Number of lines.____________------------------Length of each of french.___ .�f_________________� Type of filter material---_--pd_C.le------Depth of filter material__--/_i-'........Total length------_4"o------------------------ f - J — l Seepage Pit: Distance to nearest well___/--0-Q---------Distance from foundation----/,f_________-Distance to n arst lot line__.0 El Number of pits_______-------------Lining material---- Q1__.Size: Diameters- ldf_.-_ epe"`5 � «�_��_ LA - __ ___ Cesspool: Distance from nearest weil----------- ---Distance from foundation------------------- Lining material_____-______________-_-_-__:________- x ❑ Size: Diameter--------------------------------------Depth-----------------------------7----------------------Liquid Capacity --------------------------gals. # Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line -------------------------------------•---------------------------------------------------- -------------------------- - Remodelingand/or repairing (describe):--------- --------------------------------------------------------------------- --Q-------------•- ----------------•--------- •------------- ------------------- ------ ----------- -------•------ lnr ------f H-9 -----17A-1_--e--- '. t Q { J -- ------ ------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------•---------------------------------------------------------•----------------------------------------------------------------------------------------------- ----- --- 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 annd� regulations of the Sawn Joaquin Local Health District. (Signed)-____- /. �-WV -------{,___O_ � �_ E'-----( i�/?. ------ �1.�'!�------------------------------------(Owner and/or Contrac+orj (Plot plan, showing size of !o oca+ion of system in relation to wells, buildings, etc., can be placed on reverse side): ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - = =----------- -------- -- ---------------------------------------- DATE--- 9- ' REVIEWEDBY--------------------------------------------------- -------------------------------------------•- DATE---•--------------------- - BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- Alterations and/or recommendations------------------- ------------------- --- ----- ------------------------- ------•------ ------------- ------•----------------••---- --------------------- ------• --------------------- --------••------- --------------------•- ------------------------------------------------------------- ------ --------------•--------------- ----------------•-•---- ------•-- ----------------- -------- -- ------- ----- i ----------------------------------------------------------------------- -- --------------- - --- ----- --- - ----- _v FINAL INSPEGILON B Date � .' - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F,p.ro.