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______________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. .---- - - (Complete in Duplicate) This Permit Expires ] Year From Date Issued ` e Issued Application is hereby made to the San Joaquin Local Health District fora permit to co s ruct a� 114h Wk herein described. P This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- �( ► ... Owner's Name..-_C.J .r. i_ --------L.P A-k-kox-d-------------------------------------------------------------- ------ Phone.RO.L3 _ 'yZ 11 1 Address.......!Z-L.fh_M-— -------------------•-- ....................................................... Contractor's Name------- -----------------------•----------------------..--------------•---••-----------------------------------•-------- Phone.--•............................... Installation will serve: Residence 19 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:1f-_)..... Number of bedrooms -A---- Number of baths _'I" _ Lot size ----5_.__?s _ ___.•.....................•. Water Supply: Public system�❑ Community system ❑ Private I& Depth To Water Table q4?-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ c Previous Application Made: (if yes,date---l_0-^t.17 Z} No ❑ New Construction: Yes [g No 0. FHA/VA: Yes ❑ No L� V TYPE OF INSTALLATION AND SPECIFICATIONS: ..► (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S@ptic Tank: Distance from nearest well_________________Distance from foundation-------------------Material---------------------------,..................... i �Q_-A,t5j+�~ No. of compartments------- ----- -•---------Size---•---------------------_-...-Liquid de th_._.-.•-----•-------____--Capacity_-------------------- Disposal Field: Distance from nearest well-_(p.0_1----Distance from foundation....4.4._......Distance to nearest lot line.__:_-_-_--- -S-} �v + Number of, lines------_2-----------------------L'ength of e_-ac_h line--------ee_4?...............Width - of trench -_-_-_-_-�t_ _•_An Type of filter mate 5Ci_Depth of filter material______j.Q,ti..____.Total length---__ t_____ -__ D -_ S-_-_-_-_-_-_-__ .-_.Seepage Pit: Distance to nearest well-.._1_0Q-- mDistance from foundation-__1A_ _ ___ _ � Number of pits-----Z-----------Lining ateria Diameter_4t___A,_(0t------Dept h-------(p_______________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______-____-__ _______________----.- -_ r ❑ Size: Diameter---•-o----------- --9------------ --------- # ------Depth e th--------------------------•---- -------- ------Liquid Capacity---.....•-•t•�'--------_--gals. Privy: Distance from nearest well ___________________________________-------------Distance from nearest building_______--_-_-___________'_.._____._______, ❑ Distance to nearest lot line---{"----------•- ------------------------------------••------- , -----------• - ---------------------------------- _1_1--------•-------- r :_,---aRemoodeling and o e ainng a ..�c�....----- ---- ,S�.X�- -----•-L- -- -- 1, -----.Q4S -- --- ---�� = w OL� hereby certify that I have prepared this applicafion and that the work will be doneAn accordance with San Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. {Signed}-----��y �'- '-- `" -- - ------------------(Owner and/or ) :.. - Contractor) �I IBy=-----------••-•-•------------------------------- ----- ----------------------------------------r------------------------(Title)---•---------------------------- ---------- ------------ (Plot plan, showing-size of lot, ''locetion of system in relation to wells, buildings,.etc.,.can.be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - -------------------- -----------•----------------- --------- DATE.- .-•?-�------------- ------ REVIEWEDBY------••--•-•----•-•------'i-------------------------------------------------------------------------------------------------- DATE= ----------------------------------....- BUILDING PERMIT ISSUED_------------------------------------------••------------------------------- --:--,. D,4TE.. Alterations and/or recommendations:------------------ ------------------------------------------------• ------------------------------------------------------..--------------------------------- --------------------------------------------- ----------------------------------------- -----•--------•----------- --------------------------------------•-•----------------•-----------........------------•---•-----------------------------------•----------- •------------------------ -------- ------------------------•-----------------------------------••--••--------- FINAL INSPECTION BY:_-_-'10--,--- .----------•----------=--- Da+eQ _-_ - '`4' _ -----•-- ------------------------------------ I- Tt V L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street II 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS SM ��