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FOR OFFICE USE: f/,q 1 G� ll�� D OV APPLICATION FOR SANITATION PERMIT- Permit No. ./ _. _. ------------------ -------- --------------------------------- (Complete in Duplicate). r .. . - .,.. 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 construt and install the work herein described. This application is made in compliance with Cou tOrdinance tel . 54q JOB ADDRESS AND LOCATION.-0 v_ __ __�__-�y --- ----- --- ------- .------•------------------------- -------------- ----- Owner's Name- �.. .-!1d-2'4'L'----- e4T---- ---------------. -- Phone----- -•------------------------ Address ---------- -------- Address----------------------�.�_.�_ ....x�+..- '�----- � -t Ile Contractor's Name_- _�1r +l -------•-- --- -- ---------------------- ------ Phone.---------------------------------- Installation will serve;-'Residence R]. Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units:J_____ Number of bedrooms J---- Number of baths tai Lot si e'T ___________ s-______________________________________ Water Supply: Public system ❑.,,Community system ❑ Private.K] Depth to Water Table ft. Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam.® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: {If yes,date-------------- -- -- No U New Construction: Yes-El No ❑ /VA: Yes, ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) - ------------------------------ No. - _ _ Septic Tank: Distance from nearest ggwell_�a"--------Dis anc from foundation__�Q_----------- Material_ ee C� 7 No. of compartmentsl�_------- � !_. s.------•Liquid depth----It------------------Capacity-/�-.-------- Disposal Field: Distance from nearest wellorQ----------Distance from foundation--e0`---.-1----.Distance to nearest lot line�r�_-____-_.. (� Number of lines___J-----------------------------Length of each line---7Q---D_-!'3C?.--_.Width of trench.I�- '----.----------------- Type of filter materia}�_� -_Depth of filter material____1_Q_____________Total length_A_Yq_._.-------------------------- CC Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-..__..-_-.-__.-_ yl ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----------------_-------_-------- Cesspool• '.Distance from nearest well-----------------Distance from foundation___.--.- - -- Lining material- ______- _-- _--_-_________ ❑ Size: Diameter------------------------ -----------Depth--------------------------------------------------------------------------------------------------Liquid Capacity------------ --------------gals. Privy: Distance.from -nearest well____________________________________________-.-Distance from nearest.building__-_._--_--_____-________-_---_.____. ❑ Distance to nearest lot line --------------------------- ----------------------------- ----------------------------------------- --------------------- Remodeling and/or repairing (describe):-------------------------------------------------•-------------------•-----•---•----------------------------------------------- ------------------------- t . --•--------------------------------•-------------=--------------------------------------------------------•---------------------------•--------------------------------------------------------------=------------ ------ ----------•----------•--------•--------•-------------------•---------•------•-------------------------------- ------------------------------------------------------------------------------------------------------------ - • ------------------- ------------ ------------7---------;------------------ ---------------------------- .--------------------------- ---- ----- ------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws; and rules and regulations o the San Joaquin Local Health District. (Signed)--------- �'?7 �--- ------- F ----- ------------------------------------------------------(Owner and/or Contractor] - 1------,-• s B x - c- - f Tit e (Plot plan, showing size of lot, location of-system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _.__ DATE REVIEWED BY------------------ -•--- •-------- -------------------------------------------------------------------- DATE----------------------------- - - -------------------------- BUILDINGPERMIT ISSUED------------=----------------------------------------------------------------------------------------- DATE------------------------------------------- ---------- Alterations and/or recommendations:----•-------------------------------------------------------------------------------------------------------------------------------------------------- ----•-----------------------------------------•--------------------------------------------------------------------------•------------ ------------------------------------------------------------------•----- ------------- y FINAL INSPECTION BY:.., ,ra,-s '`........ -... ----...... -------- Date- "- "- -----. . -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Ladi,.Colifornia Manteca,California Tracy,California ES 9 REVISED 13.59 3M 3-'63 F.P.CD.