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F R OFFICE USE: -------------------- ll �- rS ..-- -- '� -------------- --. -- APPLICATION FOR: SANITATION PERMITr ;4 Permit No. __ ..... -.... - ---------- c--'-------------- (Complete in Duplicate) i . yf 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. JOB ADDRESS AND LOCATION--`f*_''_ ---- - .' - -----•=--- ------- --------------------------=------------------------------------- I Owner's Name_ --------------- Phone------------------------------------ t Addressi 4,4K-•-------- -------- -� -----_----••----•------------------------------------------------------------------------------- Contractor's Name �! ---•---------------- . -•-------------------- Phone-------•---------------.---- --- Installation will serve: Residence [F�ARpartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __`__ Number of bedrooms __-9_ Number of baths Z_-_ Lot size ______________________ � Water Supply: Public system ❑ Community systemrivate.E] Depth to Water Table 4,1144. Character of soil to a depth of3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date__________________ _) No & New Construction: Yes No ❑ FHA/VA: Yes P--No ❑ 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---40i_.Distance from foundation---/a-___.____.Mater/l_ & F ___________________ No. of com artments-.__ Siz _ ____x_ � Liquid de th__.__�/..........Capacity..��._.- Disposal Field: Distance from neare well..,-.f._Distance from foundation /�-_-___,-_Distance to nearest to line__�►f -------- Ero Number of lines_- ----------;0--------------- of each line ____ _ __________.Width of trench__,r�___________________________ Q Type of filter maferiall/ Q .___ epth of filter material_��P---._Total length___-,� _ _ _________________ G Seepage Pit: Distance to nearest well---eW_ Distance f[QM foundation-=f�_______.Distprice to nearest lot line- Number of pits---,Z-------------Lining material_ grooe_.Size: Diamefer. ._.____Deptllc Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.------_......__-._____-______-. ❑ Size: Diameter--------=-----------------------------Depth: =-----------'----- =— °.'--A_•_.Liquid Capacity---------------- ----------gals. Privy: Distance from nearest well _______________________________________________Distance from nearest building_________________________________________- 'y 0 Distance to nearest lot line------------------------------- ----------------•---------------------I—— --------- --------•-------------------------------------- Remodeling and/or repairing (describe)=----------� /-- ' =` = -----------------------------_-------_------------------- ------____________-----------------------------_---------------------------------------------__----------------------------------------------------------y_ 1 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 rues and regulations of the San Joaquin Local Health District. (Signed)-------------- - -- -- - ---y ---------- ---- ----------------•--•------------------- —i� r Contractor) -- --------------- Title - _ - ---- --------- (Plot plan, showing size of lot, location of system P* Iatrion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------ ---------------------------------- -- ----------------------' -- ---- ----- DATE------- - 6-------------------- - REVIEWEDBY------------------------------------- ------------ ------- ------- -------------------- -------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:-------�--- - ----3------f. - ----------------- DATE--------- ------------- Y BUILDING PERMIT ISSUED-------------------------------------------------------------- ---- ---------- r-- .Y,-.F. [�� cam--`--y�-r� a� �y.�-��_�c�./i l,_a�c�E_=_...t �. --- •�`Q.�.,_�/ -4c tC� c� ''�'�' �a-C'-v ......... ------ -------- ---- ------------------------------I ----------- ----•-•-- - ------------------------ ------------- 1_1e_, --- n.�?n117=''"z--'l` 4--L�— -�'�-- ee_- '--c._Li �-c r �--�'ct' --nt~ •�-�. 2-`t�-E � FINAL INSPECTION BY:----- *..... �--------- �----=------------ Date-------- � ----- �.-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton AV*. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 3M 3-'63 F.P.CD.