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FOR OFFICE USE: ---------- -------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. y/...2- .... ------ (Complete in Duplicate] Date Issued ----71- 1XII,- This Permit Expires 1 Year From Date Issued 2-of- W v - ct annstab�e. Application is hereby made to the San Joaquin Local Health District for a permit to construd ill the work herein clescr-, This application is made in compliance with County Ordinance No. 549. Be-4", JOB ADDRESS ANY7&ATIONV67;7t� ------- ------------ J.- f Phone----------------------------------7- Owner's Name------ ------------------------------- ---------- -------------_---- Address--------43.- -------74.f' --------------------a- ------------------------------- Contractor's Name__.--_- ------- -------- -------- Installation will serve: Residence. Apartment House 171 Commercial ❑ Trailer Court ❑ Motel [I Other Number of living units: ___/___ Number of bedrooms ___?_ Number of baths ---7�L& size ---- I. Water Supply: Public system El Community system 9 Private [j Depth to Wafer Table --- Character of soil to a depth of 3 feet: Sand ❑ Gravel F-1 Sandy Loam El Clay Loam [3 ClayZ Adobe ❑ Hardiian 0 (p, ' 11 "No,Z `1- I N New Construction: Yes FHA/VA: Yes Previous Application Made: (if yes,date---------------- 09 _j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6ric sewer is available with;I n 200 feet.) f un a ---Matt A. ........ Septic Tank: Distance from nearest from I tion...1_4�------ , . L Liquid dep�h------ ----Capacity-1-2,I��__ No. of compartments-1---------------------Size---oil------- Dis�ance from nearest well__:�O .4--Distance from foundatiq_n.__,2_..z_'). Distance to nearest I line____ ----------- 0 Of I ------- trenc�__A-14 Disposal Field: Number of lines--- ------- ------.---Length of each of Z( ---------- terial _&k--Depth of filter material--- ---Total length___._ _'7----------------------- )-.A -,3-----7E Type of filter ma -----------Distance from foundation----------------_Distance to nearest lot line____-_----___.__ Seepage Pit: Distance to nearest well-_-----__-_.-_.___-_- of pits---------------------Lining" material------------------ ._S�ze: Diameter---------- -----------�Depth--------- ----------------- ---- 171 --------------- Cesspool: Distance from nearest well-______--___--_ Distance from .foundation_______________.....Lining material-------- -------------- - -----------Depth---------------------------------- ------ - ----Liquid Capacity-.-------------------:------gals. El Size: Diameter-------------- ----------- k�__ - . —Dista-nC6-frorn nearest buil in --------------------------------------- - —Distance-froin 6ea`risfwell-___—-------------------------------- ---- 0 Distance to nearest lot line-_---- -------------------------------L---------------------------------%I---------------------------------------- ------------- ------ Remodeling and/or rqpairing (describe) __:------- --------------------------------------------------------------------- - - --------- --7---------7---------------------------------- ---------- ---------------------------------------------------------------- ----------------------------------- ------- -------------- ----------I------- --------------- - ------- ------------------ ----------------------- ------------- ------------ - --------------------------------- h San Joaquin County ----------- ----- I hereby certify that I have prepared this application an that the work will be done in accordance wit ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---------------(Owner and/or Contractor) - ---------� ------------------------------------- (Signed)--' 6, 1. ----------- ---------------(Tit] -------------------------------- --- - -------------- By:------------------------------------- -------------------------------------------------------- --------------- 1 1!1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. can be placed on reverse side). — FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ----------------- ----------------------------------- ---- DATE------------------------------------------------------------ __:� DATE - - - - -_ -------- --------------- REVIEWEDBY-------------------------------------------------------------------------------------------- - ------------- ----�� ' J DATE--------------S 4 --------- -------------- BUILDING PERMIT ISSUED---------------------------------- --------------- - -- --------- DATE ---------- ----------•------ ---------------------------------------------- Alterations and/or recommendations:_____--------------------------------- A/_ --------------------------------------------------- ------------------------------------------ ----------I------------I-------------------- ---------- --------- ------------------------------- - -------------------------------------------- ------ ---------------- ------------I-------------------------------------------------------------- --------------------------------------------------------------------------------------------- ----------------------- ---------- ------------------------------------------ ------------------c_ ------------------------------------------I ------------------------------------- ----------- ----------- ---- -,r---------- --------------------------------------- ------------------------ ----------- -------------- Date_------ ---------- ------------ ------------- ------ FINAL INSPECTION BY:-.-, ---------- -------------------------_.- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Kaxelfan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sire., Stockton,California Lodi,califofnia Manteca,California Tracy,California r6S SO REVISED B-59 3M 3-'6:3 F,F3.C;[J. 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