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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No -------- -- -------------------------------------- 1. 42_L.__�> -------------------------- -- ---- -- ------------------ (Complete in Duplicate) -------------------__---_------_------------------------- This Permit Expires 1 Year From Date Issued Date Issued ------------- 212 •- ( o � p 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 incompliance with County Ordinance No. 549. .E /7J C-C JOB ADDRESS AND LOCATION------ --------- ------''iry 2- ----- "`' ----------------- ----1 - -- -------- Owner's Name - �"� -- !j e f " -"°' -------- - - - -- - --- - --- ------ ------ Address---------= 3 i. `"-' ___- -! c ---------- -------------------------------------------------------- Contractor's ------------------------- ----------------- - ------------------------- ---------------------- - Contractor's Name ----------------- =- -- Phone------------------------------ Installation will serve: Residence 2;._xparfinent House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___._{_ Number of.bedrooms ___.2 Number o baths __1____ Lot size --110--_ ---446____________________________ Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand-[j__Graver❑ Sandy Loam E] Clay Loam El Clay E] Adobe &--Oardpan C] Previous Application Made: (If yes,date----_---------------) `Na [ New Construction: Yes No ❑ FHA/VA: Yes ❑ No Er: R TYPE OF INSTALLATION AND SPECIFICATIONS. .,�. (No septic tank or cesspool permitted if public sewer is'available within 200 feet.)If � Septic Tank: Distance from nearest weIIS.�----_____Distance from foundation__.Id------------Material__ ----- ----- ______ ______-------------- s� [� No. of compartments----�________________Size___ _�' _---___ _Liquid depth_-_4_ -_�_-_-- Capacity.$ 6 _ Cr Disposal Field: Distance from nearest well_-5 __.._.Distance from found tip _f6__r__.____.Distance to nearest lot linei . Number of lines---.-----�-------------------Length of each line---` -- -------------__- idth of trench-Z_ -------------------------- o Type of filter mate rial___170c.. _____Depth of filter material-_/Z--".__________Total length_,C-I,,o___---------------_------------- G Seepage Pit: Distance to nearest well---------------------- from foundation______-__.I....°.Distan e to nearest lot line__y_________--- ❑ Number of pits--------------'-------Lining material-----------------------Size: Diameter------------------------Dept h----------------_----_-----{__-- Cesspool: Distance from nearest well-----------------Distance from foundation------------_ ---- Lining material_.__-.__________._______________.___. El Size: Diameter-------------- #------ ---------De th----•--------------------------------------- ------Liquid Capacity -----------gals, Privy:. Distance from nearest well-----_._-_______________y________________--Distance.from.nearest building._.-_-_____--__--- --------. ' ❑ Distance to nearest lot line---------------=------------------ --------------••--•--------- -----------------------------•--------------=_------------------ ' 4 Remodeling and/or repairing (describe): - -------------- ' t t u •iced ��GC --------- --------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------•------;----------------------- � ; I hereby certify that I have prepared this applic4fo t the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations ofquin Local Health District. (Signed)------------------------------------------------------------------------ - -- - ----------------- ------------------------------------------(Owner end/or Contractor) By:----------------------------- -----•---• ------------ -------------------------------------(Title)--------------------- --------- ------ (Plot plan, showing sizeof lot; lova+ion of syst rells;buildings;etc.; can be-placed�on-reverse side). - ._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ --------- ---- ------ ---------------- L r DATE------- �------------------------------ REVIEWEDBY------------------------------------------------------------ -------------------- -------- ----------- ----------------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------- --------------------------------------------- DATE--------------------------------------------- -------------- Alterations and/or recommendations-------------------------------------- -- --------------------------------------------•-----•--------••--••-------------•-----•------------------------- ---•---------------------------------------=-------•---:--------------------------------------------------------------------------------------------------- -------------------------•--------------------------------------- --------------------------------•--------------------••----------------------------- ---------------------•------------------------------•----------•-•---•----•------------------------------------------------------------ --------=-----•---------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------ ---- --------------------------- - _..--------•------------------------------------- ----- --------------------------------•-- LL -------------- FINAL INSPECTION BY--------------------- -- .. Date--------•----- = Y J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 5.Ho:elton 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-•63 F.F.CD. S •