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�OR O FICE USE: ��aT - = � y `-------------C {, .............�qxr----- APPLICATION FOR SANITATION PERMIT Permit No. ....1 - -------- -- hcate d ( p F. 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. i JOB ADDRESS AND LOCATION--------__45----------- /QVC-.0 / —---------------- Owner's Name. 1�l-. ... Q L 1-{/�_/C------------------------------------------------------------------ - ------ Phone-Z7i9 Address............._---------C.4 —I_9 ) Contractor's Name--------- ..15-f/---------/t C.- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---r---- Number of bedrooms 2-77 Number of bafhs A---- Lot size ----_.�5--T-- Water Supply: Public system 0 Community system ❑ Private Fj Depth to Water Table 60- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑1 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No)o FHA/VA: Yes ❑ Noo " 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 foundation_-------------.----Material__----.-----....-----------------___----..----. ❑ 4� No. of compartments--- --- ---- -------------Size----------------------------_---Liquid depth--------------------------Capacity------------ ------ Disposal Field: Distance from nearest well.`�'> Q-Distance from foundation------Imo'-�:`-Distance to nearest lot line-_,3 �--__. ��Number of lines----------- ----------------------Length of each line---------3 ---------.-.Width of trench---------2 -----._______.--- Type of filter material- _1.e Depth of filter material---------Z ...... otal length-----------------------c3s`'------_ V' Seepage Pit- Distance to nearest well.- `+* . Distance from foundation--~" '-----..Distance to nearest lot line---S--.--_.- 6,d4b Number of pit s---------/-----------Lining material--,5•-A?0--4-_Size: Diameter--- - --'�----Depth------------- ----.-- Cesspool: Distance from nearest well------------- Distance from foundation____.--------------Lining material------------------------------------- N ❑ Size: Diameter------- ----------`-r ------Depth---------------------------- ------- -------------Liquid Capacity-- ----------------------_gals. Privy: Distance from nearest well--------------------------------------------------Distance-from nearest building----_----_-------------------------------- V ' Distanceto nearest lot'line.--- w=-•----=------------- ---------------------`----•------------•-- ------------------ -------------------------------------------- �. Remodeling and/or repairing (describe)--------------- ----------- Y/ST//v-t '-------cS •a-------------------------- -----------------•-------- y ---------------------------------------------------------------------------•--------------------------------=---= "--..:-:-------------------------- ----- ----------------------•------------------------------- �. -+ �'='- •------------------------------••----------------------------•------------------- ---------- i 'I hereby certify that I have prepared'Ais'application and thaf 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. (Signed)------------ -------- l�6------------------------------------ (Owner and/ar Contractor) By:---------- - - -------00--------------------------------------IIv -----------------------------------------------------Title 0- ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- i DATE-!_._ ------------------------- REVIEWED -c -- � __�`r�-.----, -.REVIEWED BY - DATE ---------------- -----•-----------•---------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------•-- ---------------- ------------------------- DATE----- ------------------•--------------------------------- -- Alterations a d/or re mmendations: ---' ------------------------------------------------------------ vEsc , " - -- ------- -------------------------------------------------------- ' ------- ----------- ----------- r. ... - �� = ---------�---_---------- f t r I ---------------------------- -------------------------------------------------------------------------------------------------------------------•--•--------•-------------------------------- --------------- " r � � s FINAL INSPECTION BY. .r- FGo' Date �,r �----- - ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M 3-'63 F.P.0 D.