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FOR OFFICE USE: -- --------------------------- ----------------- APPLICATIO- N FOR SANITATION PERMIT Permit No. -- ---- _ �- (Complete in Duplicate) ----=---- ---- // -.-----.--- This Permit-Expires 1 Year From Date Issued Date Issued`.___ Thisication is applicationis madereby in compliance with e to the Son guin Countya0 dine ce District a permit to construct and installa work herein described. t I . - -----� - JOB ADDRESS AND LOCATION.: Owner's Name „ - ------.---- • = = Phone 4 ��[[ -- Address---------------------------I-`.......0 f -------------•-----------------------••---------- --- -------- Contractor's Name _---- ----------------------------=----- -------------------------------- ----------- Phone. Installation will serve: Residence Apartment House ❑ .Commercial ❑ Trailer Court ❑ Mot I. Other ❑ j Number of living units: �_____ Number of bedrooms _��__�_,Number of baths ____ ' Lot size --------- _____________________________________ Water Supply: Public system ❑ Community system ❑ Private:$,Depth to Water Table _!E_41 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobe [�/ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction:�Y�e� No ❑ FHA/VA: Yes ❑ �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '��`'= u {No septic +ank or cesspool permitted if public sewer-is available within 200 feet.) � Sepis Tank: Distance from nearest well___�a__:Dista a from�foundatdon____/-�____.Materral_L_._" r No. of compartments.____Y______________S.ize_ ,`__�-____+____ .___Liquid depth__-___ �______Capacity_____ _d _ Disposal Field: Distance from-nearest- II...___/.U___.Distance from foundation--------76---- Distant -to nearest lot Number of fines_________�- ______--_Length of each line__�_�_7_/b 6_— /� VidtK oPtrench._______�--- ��_____.._ a Type.,of filter material__< Depfh of filter material-__._.__J., _:___._Total .length___________?-� ___`________._ Seepage Pit: Distance fo nearest well____________________Distance from foundation-----------------.__.Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter ------------------Depth--------------------------------- Cesspool: Distance from nearest well_______-____-_Distance from foundation __________________Lining material-------------------------------------- . ❑ Size: Diameter-------- ----- Depth--- -------- --- -=----Liquid Capacity---------- -------------gals. r:_Distance f�nrn ne�'ie; 'b'uilding------------------------------- ---- --, !p" ❑ Distance to nearest lot line = = --------------------'---------- Remodeling and/or repairing (describe):--------------------------------------= `------------••-----------------------------.-----------------------...------------ ------ _______________________________________________________________________--._-_____--_-__-___________________-_.____.__.__:-______._________-__-_________-.-__.______-_._______________.____________________--___-._..__... F _________________________________________________________________________________________________.___».___.-.-.._____________--_____--__---_-.___________.____--___-_______-_-____-_-i__:--_-_______-___..__________--_..._ 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 re `Iations of the San Joaquin Local Health District. {Si ned) . 9 �� f r ------------ .(Owner and/or Contractor) By:------------------------------------------------------------ • -------------------------------- = °F Title I - -------------- -- { )------------ -•-------------------- (Plot plan, showing size of lot, location of system in relation to wellsv:.buildings, etc., can be.placed on reverse side). . FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY-------------------- ----------------------- = - ATE - REVIEWED BY DATE__. __L � `---------- BUILDING PERMIT ISSUED ------------------ ------------------- - DATE ------ Alterations and/or recommendations----------- ---- ------ --------------------------------------------------•------------------------------------------------------------------------------------ ---------------------- } f ____________________________________________________________'C------------------------- ___ _ FINAL INSPECTION B . ----------- -- -------- Date ------------------5�= s5 ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Ledi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.p,CD.