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FOR OFFICE USE: --------- ------------- Permit No. ... --- -------_--------4 t - APPLICATION FOR SANITATION PERMIT _____-----_-------- (Complete in Duplicate) 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--- - -!/7�--------%--- �"�"-`y"'' hone- lo. 0 --------------------------------------- Owner's Name •---------------------- ---------- ----------------------------------------- ---�---- ------------Address_. . Phone------------------•--L-r-1--r--�------ Contractor`s Name----------- --------------------------------------------------- ------------------------------------------- f Installation will serve: Residence F1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -1----- Number of bedrooms _"j-_-- Number of baths I---_ Lot size -------- S f Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table -------- ft. tj Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam IQ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------"---------I NoX New Construction: Yes ❑ No K FHA/VA: Yes ❑ No) G 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__..5!--------Distance from foundation---l0_�_-___-_-.Material._-- 2�.LelrSo- ------------------ No. of compartments------' ----- Size.. .__X-9 -------Liquid depth_ .'7;�Z-----------Capacity----------------------- Disposal Field: Distance from nearest 'ell._ Q.�--- Distance from foundation--:-la l._..._Distance to nearest lot line_"__rJ`:_--___-- Number of lines-----------------------------------Length of each line------------------------------ Width of trench.-----r Type of filter material,eoe/t-__-_--Depth of filter material-__/�------------Total length---- ------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line_---_---_--_--_-- ❑ Number of pits".............. ------Lining material---------------------- Size: Diameter-------------- -------.Depth--- ----- ----------------------- . - l Cesspool: Distance from nearest well-----------------Distance from foundation_---------.------_Lining material - als. ❑ Size: Diameter------ ----------------- ------------Depth---------------------------------- ---------- ------Liquid Capacity----------------------------9 1 Privy: Distance from nearest well-------------------------------------------------DIstance from nearest building------------------------------------------- Distance .,-------_____.------------------------Distance to nearest lot line----- - ---------------------------------------------------------------------------------------- - --------------------------------------------- � � �' � Remodeling and/or repairing (describe:-----�/��`S9-��--- --�=-- ----1_��c�--------•�------�----•- --�.��-�---m----------------------• -------- ----------•-----I------------------------------------------------------------------------------------ -------------------------------6 ------------------------------------------------ - 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 an!�.regulations o� the San Joaquin Local Health District. (Signed)--- I ` , , (Owner and/or Contractor) (Title) ---- --- -...---------- --- gY� 9 P (Plot plan, sho ng size of lot, location of system in relation to welts, buildin s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ----- - DATE------------------------- --------------------------------- -------------------------------------- REVII=WED BY--------------------------------------------------- ------------- ---------- -----•----- --------------- ------ - DATE------------------•-------•-------------------------------- BUiLDING PERMIT ISSUED-----••--------------- ------------ ------------------------:—-------------- - -------------------- DATE------------------------ Alterations and/or recommendations:"------------------- ---------- ----- -- l ------------------- --------------- ----------------------------------- - -- - ----------------------- I " FINAL INSPECTION BY:... -- - -------------- - Date------d------- � s ----- --------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Are. Soo West Oak Street 124 sycamore Street 205 West 91h Street stockfon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CC.