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FOR OFFICE USE: ---""-"----------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------- -------- ---------- ------- ---------- --- (Complete in Duplicate) issued � _ ----`'off- � This Per Expires''! 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. 'Z- ,Sr30�C9'� This a lication is made in compliance with County Ordinance No: 549_ JOB ADDRESS A L CATION � ''"'� f --------=--- ------ Owner'sPhone --- --. -_ ---- Name___________ ____ r X�i4_1144& --------Address =---- -- --- �------- ----------- one ------------- Ph ----------------------------------- Contractor's Name-------- ...-- -- `' ` Installation will serve: ;'Residence Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Ocher ❑ I. Number of.living units:,-l____-Number of bedrooms __ ,?- Number of baths -- .-_ Lot size Water Supply: Public.system ❑ Community system ❑ Private ,e Depth to Water Table _...___ {}• i Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ ❑ Previous Application Made: {lf yes,date____.......... ....) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: °(No-septic tank or cesspool--permitted if.public sewer is available within 280 feet.] _ � < r Septic Tank: Distance-from nearest well___ _______Distance lido foundation ---- - " Capacity-n No. of com'partnients -5ize,�: f Liquid depth--- ----------- ---1- } , 4i z} Dispos Field: Distance from nearest wel!_. .- Distance-from-four:dation: '-�" -- •Distance to nearest lot line. y" Y� �- Length of each line---_--- -----.Width of trench ---- --j-,------------- g a= T umber of filter material_ ' nes • ---t_/�e_--_----Depth of filter.material------�-�-------------Total length------:��-�----------=------------ Seepage Pit: Distance-to'nearest"well_____________________Distancefrom foundation___.___.______.____.Distance to nearest lot ine__.__.___________ ❑ x Number of pits-------------------- Lining material --- Size:Diameter Depth _j _. s ,� Cesspool: ,�, - Distance from nearest well-----------------Distance-from foundstion__..__________.___ dining materia__.__.______-_________----=-----:"-•-. ❑! Size:'Diameter =`---- ------------- Depth_:_w _ ,, ,.�.- " -- Liquid Capaaty_. -{ gals. -W - t , Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------ Privy: - ❑ r Distance to nearest lot line------ ----- --- -------------- ------------------ -------- ----- { Remodeling and/or repairing (describe)- --------------------X--------- - ------------------------------------------- -----------------------------------------1--1---------------------- ---------- ----------- ----------- ------ : ---------------- --- t; ! h-ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat s, and rules and regulations of the San Joaquin Local Health District. and/or Contractor) a -- -------------- ------------- - n (Signe- 01 By:------ -------------- --'--•---- -- -- -- -- --------------------------------`-----------------------(Title)---------------------------------------- - (Plot plan, shows 9 size of lot, location of.system relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---- ------ -------- DATE_ f� c f REVIEWED BY--------------------- -----------------------:-------------- - DATE ' - - ---- ----------- - DATE------ -= --------------------- -- ------- -------------- BUILDING PERMIT ISSUED--------------------------- --------------- -- .:. : _ w Alterations and/or recommen atrons__________________________________ ...... . °--------- ---•------------------ ---- 4 .. ... r w•..- -17 7' y FINAL INSPECTION BY:- --_- x' ----------- ------- Date-- -------- ----- --- - - --- ---- ---------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3•'69 F.P-CQ-