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FOR OFFICE USE: G. ---------------- 3__--_ APPLICATION FOR SANITATION PERMIT Permit No. ..� -� .1 (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: 54 CZ44__ JOB ADDRESS AND .LOCATION------ 8 6a-/--�-----�-------_---------- ----------------------------------------------------- Owner's Name------�e!_A4-------------------- _.�- P1 Phone------------------------------------ - -------------------- •----------- Address----------� �`�--`-5- � "t �� ---------------------------------------------------__------------------------------------------------------- -•I� -------------- ------ Phone----------------------------------- Installation Name-..---• ----------•------__---- -• - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E3 Number of living units: ...___ Number of bedrooms __d__ Number of baths ___ Lot size ___` P--- --Z. -------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water_.Table _ Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date__ _________________1 No New Construction: Yes gj-"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public,se'wer is available within 200 feet.) 4r Septic nk: Distance from nearest well_��________Distance from foundation 1--____________. ____________________________________. I [ No. of compartments----_a-------------------Size---3Y�S -------Liquid depth-----I-..---------- Capacity q ____Ca atit 2-0!q! •- Disposal Field: Distance from nearejt well- ----------Distance from foundation.16______________Distance to nearest lot line..(§ ....... OA [� Number of lines____- _________________.___ Length of each line___- '--____ - --- of trench___�_S' ____.___.._______- Type of filter material_�.�_a_C_��-------Depth of filter material-_t�i'_�`_________Total length_:__- ____________________ a of 4r Seep g if: Distance to nearest well_-.__—__-________Distance from foundation________________Distance to nearest lot line_______________ f� Number of pits-_-:_�•__-----------Lining meterialFT4C.-'t----:.Size: Diameter-134--�'._______.Depth_-_-.rZr_'_-______------._ r Cesspool: Distance from nearest.well-----_-----------Distance from foundation-------------,......Lining material____.___-_-:____________________.___ 0 Size: Diameter--------------------------------------De th--------------------- -----------------------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------- --------------_------_--- ElDistance to nearest lot line---------------------------------------------- ----------------•-•------------------------------------------------------------------------- Remodeling ------ Remodeling and/or repairing (describe)------------------:--------------- -----------------------9---------------------------------------I---------------------•--------------------------------- -----------------•--------------------------------------------------------------- ------------------------ -----------------------------------•--------•----------------------------------------1___-- --- -------- -----------------1*----------------------------------------------------------------------------- - ---------------------••-----------------------------.--•--••---------------------------------------- --------------------------------------------------------------------------------------------•------------------------------- a - ----- ----------------------------------•--_•---------------------------------------•-----------------------------------------------------•----------------°------------------------------------------------------ -------- 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 he n Joa in Local Health District. (Signed)------------------------------------------------------------------- -------- ----- --------------------------------------- ----------------------_--(Owner and/or Contractor) kBy: ------ ----------- -- ------ ------=---------------------------------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C� i ----------- -------------------------- DATE-----j a --------- --------- -------------- REVIEWED BY------------------------------------- ----- - ---------------------------- - -4-1; -------------•--------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- ---------- -- -- ---- --- DAT Alterations and/or recommendations:_-�� ._____-- _ -- •' ---- - �.. -- ---- --- ----- :. - - ---- ---------- ------ ----------------------- - ------------------ ---------------------------------------------------- ------ • •----------------------- ------------------------------------------------- -------------------------------------- FINAL INSPECTION BY:----Q--=----- ------------------------------ Date-- --- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California es 9 REVISED 6-59 3m 3-'S3 F.P.C:0. ---r