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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .•�-7 - .�-.-- (Complete in Duplicate) . �.. ------ -- ---------------------------------- ------------ �.µ.. _ _ This Permit Expires 1_Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work er 'n described. This applicafion is made in complian with County Ordinance No. 549. 3S"-v it/�,t;"B Art ! S, C��eA JOB ADDRESS AND LOCATION_1 ______J�____� ____�.�_ -------------- �I - f P Owner's Name--- ------1� _`4--711_0---•-- �------- ----- -- Phone-----------------. --_ - --- -- Address--------- ---------`-�-•---------.... ..... ------... . ------ --=------------•--------------------•--------------------------------------------------- Contractor's Name ,fir`--------- - Phone Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [) Other ❑ Number of living units: ---- Number of bedrooms __ Number of baths Lot size zD________________________________ Water Supply: Public system ❑ Community system ❑ Private Ej'Depth to Water Table _�nf. F f y, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [!I-'Hardpan ❑ Previous Application Made: {If yes,date----------__________1 No [, New Construction: Yes DR-INo ❑ PHA/VA: Yes ❑ No B TYPE OF INSTALLATION AND SPECIFICATIONS: •; T . ,. #. �....;..:_:.,r - ._ _ _ _.� .,.t.,;._ -tet .:-.,,. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) rrte�; Septic Tank: Distance from nearest welljl�l_e______Distance from foundation__�A__f_ ____Material___1 ' ______________ No. of compartments----�---------------Size----- -K S--X-�__--.Liquid depth------�__r------------Capacity--- Dispos Field: Distance from nearest well Distance from foundattiion�__�_ 7_�____-Distance to nearest lot line----47.:"__ Number of lines____�_ _ ___.___ Length of each line- -�_. _ Width of trench---/Z_41'______________________ Type of filter maters-al:___ _ .__ . p 6r �� A- iT1 -----Total g .-_De Depth of filterrlaterial_________ _____ _ Total len th______ _G_Q______.________ 4 Seepage Pit: Distance to nearest well ______________-------Distance from foundation--------------------Distance to nearest lot line_____.____.______ ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth--------------------------- t Cesspool: Distance from nearest well________________Distance from foundation.._. Lining material.- _.--------------- .___.______-_-- ❑. Size: Diameter------------- ---- - -----------Depth----- ---------------- --------- ---------------Liqui.d.Cap-acity -----------------lnals. Privy: Distance.fram,nearest well------_----------------------:-___:___-________Distance from nearest.building------------------------------------------ ❑ Distance to nearest lot line ` - Remodeling and/or repairing [describe):'----------------------------------------------------------------------------------------•--------------------••'----••-•--------------•-•-------------- a : T 1 -------------------------------------------------------- •--------- ------------------------------------------------ ---------------- ----- ----------------------------------------------------------=- •------------------------------•---------------------------------------•---- ----------- ------- 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. r-les ncl reg ions of the San aquin Local Health District. t i (Signed) #. --- -------= ---------- {Owner—&Wor Contractor) --- ---------- r r. I BY:--------•--------------------------=------------------ -----------------------------=-=-------------------==------------------ --------=-----:----------- ------------------------------------- (Plot ---=_-..__- - - - ---- -------(Plot plan,:showing size.of.lot, location of system in relation fo wells, buildings, efc., can be placed on-rever'se side). ' 1.4 r -FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------------------------- --- -.------------------------------------------ DATE---- ------------ -------------------------- REVIEWED BY--------------------------------------------------------------=----------- ----------- -- --- -- DATE- -" --- -------------------•------- BUILDING PERMIT ISSUED--=----------------------:- -------------------------------------- --- 1- DATE------------------------------------- ----------------------- Alterations and/or roinmendations----------- - ----—-------------------------------- -----.- --------------------------- ---------------•------------------------------------- { " ----------------------------------------------------- - --------- --- ------------------------------------ ` - ------- ---------- ------------------------------- ----------------------•------ ------------------:------------------ ----------------------------- ---------- -----•-•----•--------•--------------------------------- --- } FINAL INSPECTION BY------------------- 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 II CS 9 REVISEO 9.59 3M 3••63 F.P.CO.