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rUKUFFICE USE: — - -- --�---� y ----------- ------------ .........----------------------- APPLICATION FOR SANITATION PERMIT Permit No. 3s . -------------------•----------------------------------- (Complete in Duplicate) Q ------------- ----- This Permit Ex fres i Year From Date Issued Date issued Application is hereby made to the Son Joaquin Local 'Health District for a permit to construct and installthe work here described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ --------� * ✓�! �w = f "� off ~ _ / A q, Owner's Name___________ L+ -----------------------•----------- ----------------------------------------- Phone.�J Address------------ `'7 O 0 Contractor's Name-------------- '------ -_ - ----- -----------�---= ! [ Phone.. e 3_ c/_o_ '/ Installation will serve: Residence ❑ Apartment HSuse ❑ Commercial J@ Trailer Court ❑ Motel Other , Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ........ Water Supply: Public system ❑ Community system ❑ Private 14 Depth -ro Water Table -------- ft. Character of soil to a depth of 3 feet: Send 0Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [❑ i Previous Application Made: Ilf yes,date____________________) No New Construction: Yes ❑ No ❑ I HA/VA: Yes ❑ No 19 1 . - `"TYPE OF INSTALLATION AND-SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet. } Septic Tank: Distance from nearest weil__- o d I p __�--_-----Distance from foundation-----�---•-•-- Material-----G_aN-c•?�-�.��------------- DdNo. of compartments-----------•--•••--------Size___ A�F.r1------------Liquid depth------`/- ..--------------Ca pacify_ --- - Disposal Field: Distance from nearest well-_______________Distance from foundation--------------------Distance to nearest lot line ❑ Number of lines..!_-••-----------/--------------Length of each line-------- a_----------_.. . .Width of trench..---r3.Y_y'....---_-_.____._.....____..._..-... Type of filter material.-/,'-__ oc-�---_Depth of filter mater4l____ _a_��.---__:.Total length____.... _P...�_. ----------•----- Seepage Pit: Distance to nearest well______________________Distance from foundation_....___ -----------------Distance to nearest lot line_________________ ❑ Number of pits--------1_----------Lining matanal �_ ._. ac '-size: ,Diameter__ _ /O ✓'b_-Depth-------6--------------------_ Cesspool: Distance from nearest well---------------.-Distance from foundation.---------.__._.Lining material___________________________ --- ❑ Size: Diameter. Depth.. --------------Li Liquid Ca Capacity -------gals. Privy: Distance from nearest well-----------------------------------------._____._Distance from nearest building ---------- ❑ Distance to nearest lot line---------------------------- OL Remodeling and/or repairing (describ.0)_------------ke 04_46 � Q ------ ---------•--------- ----------_--- ------ ?•-•---------- 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 and 'regulations of the San Joaquin Local Health District. �,f� i �f (Signed)- C -- -------- - --------------------•-------- ------------------•--------------- ----(O .. ._ - Contractor) By-_----------- - ----- --- ---- ------ ----•----------------------------------------------•-------•------- ••- -----(Title......6e _...s `Gv?GP or ------------- --------- (Plot plan, showing size of lot, to ' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y ,Rs— --------- ---------------------------------------------------------------- DATE------- ' IEWEDBY-------------------------------------------- ------- -- DATE------------------------ ATE.-------------••------ -- - ' - . •------------------ U1LDlNG PERMIT ISSUED_----•------------------------- Aerations and/or recommendations:_______________ ,_ _ _ Df4TE------------------------------------------------------------- --a -----T P--__--_ �-------------- -------------------- ------------------------------------------------- ��- ... R�''M ---------Jopp�?��(1�l•------------------...--•---------------------------------------- -------------••--------------------------------------------- .134 I----------- - ---- - -------- ----------------- - - -: .--- FINAL IN5PEC -• -- --- -- -- ---•----- - ( Date---------- -- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 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 5-52 ATLAS