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F OFFICE USE; .� Permit No. . _-_ ?'t'- ------ APPLICATION FOR SANITATION PERMIT 7 ------ -------------------------------------------------- (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 e�� construct and install the work herein described. _ This application is made in compliance with C unty O \ e No. 549. 0 I t JOB ADDRESS AND ATI - -- - ---- -' L ----- Phone -Owner's Name___, _._ - Address._.___ f $ ..1 ----- -•-----------------------------------•------------ Contrector's Name---------------- '------------•------- -•--------- Phone----------------------I------------ � Installation will serve: Residence [impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. Number of bedrooms _ _ Number of baths. yLot size __ g - �--- - Water Supply: Public-system ❑ Community system Ra"'Private ❑ Depth to Water Table 455 J tt. ; Character of soil to a depth of 3 feet: : Sand ❑ Gravel ❑ TSandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91-111ardpan ❑ ` Previous Application Made: (If yes,date---__-_---___-_--_I No ®!New Construction: Yes Zj-'No ❑ FHA/VA: Yes Z ^No El TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_._-_`—____Distance turn founcla ion_-/�--_____.Mat /- _--------A6 -- ----- No. of compartments----- ---------------Size_ ' -- C- -----Liquid depth__- .�,-------------Capacity._ -------- -Dispos�a�eld: Distance from nearest welL___ry.____ .Distance from foundatio-ny_� -----------Distance to nearest lot line ------- 9K"– _ L' ' — -----Width of trench--�--------•--------------• 1, Number of lines.-_..�--�----- ---_-- ength of each line-_____ � ,, � Type of filter material_ _� d�7epth of filter material__ ) -,_-_Total length__ _ _ i, Seepage Pit: Distance to nearest well-------7'.-____Distance from foundation__A19--_____.Distance to ®� - neatrehst loin- __ Size: Diameter__ _ DelNumber of pits-_-- -.--Lining materia_ i Cesspool: Distance from nearest well----___________-Distance.from foundation---------------------Lining material-------------------------------------- A ❑ Size: Diameter-------------------------- -----------Depth_------------------------------------- ------ ----Liquid Capacity- ---------------------------gals, r Privy: Distance.from nearest well---------------------------------------- --------Distance from nearest building---_- --------------------------------- -- ❑ Distance to nearest lot line< ---- -----------r------ ----'-------------•---•,------ ------------------------------------------------=-- II ------------------- -- Remodeling and/or repairing (describe)--------------- `�---1-114 -- - -- •--- - -- -- - ----- ----- ----------------- --------------------------------------------------•-----------------------•--•----------------------_-----=--•--------==---------- --------------------------------------------- { =------•------------------ ---------------------------------------------------- ------- ---------------------------------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County °t- ordinances, State laws, and rules and regulationsf the San Joaquin Local Health District. Si ned __(�or Contractor) ---- -- ------ -- By=---------------------------------------------------------------------------- - --- (Title)f � ' (Plot plan, showing size of lot, location of system to re on to.wells, buildings, etc., can be placed.on reverse side). FOR DEPARTMENT;USE ONLY, " APPLICATION ACCEPTED BY-------"---` -- -------------- --- ---- ------------------------- DATE----------- ---E ��" REVIEWEDBY----------------------------------- ----------------------------- ----------------------------------- ----- DATE------------------------------------------------------------ P PERMIT ISSU ED - ---------- --•--- DATE -------------- ---------- ------------ ---------------- and/or recommendations•-_____-.---5-_.-_-._------------------------------------••--- -- --------- �" .�` -------`tl - �------- c :L t = i `- -----=----•-------- ........ -------------- •----------------------------- ----------------- --------------------------------- -------- --- -- Date---FINAL INSPECTION Y: - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazellon Ave. �, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California. Lodi,California Manteca,California Tracy,California E5 9 REViSEO 8-59 3M,31-'63 F.P.CO. LFILY-H. ®31 - .�ewaw...y�