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_ FOR OFFICE USE: --------------- K�----------------------------------------- ____-.--__ -- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ ----------. -- (Complete in Duplicate) O ----------- 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,ins'all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 1Cr['oI-Al -------- - -----------`--- Owner' Name---- -------- ------ Phone---r- ---e-�-°-------------t---o--•-y-• - Address '. z r ` ...... _-_ __._.._. _. Contractors Name-----------Flll ± .uc' ---- ------ ------ -- -, .- ------------•- ---------- ---- ------ Phone............................. — Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- Number of bedrooms ___,Number f baths = Lot size _____ ---------------------- Wafer -------- ------Water Supply: Public system a Community system ❑ Private Depth t Water Table -:-_-__. ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam' Clay Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote-_-.____.- -__) No ❑ New Construction: Yes ❑ No ❑ F>[A/VA: Yes ❑ No ❑ TYPEOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c � Septic nk: Distance from nearest welt.... ___.__Dista}Ce from foundation__-- 'dMat erial_____ " -----_-_-_. r No; of compartments_.____---------- _______Sizerj`_ __ _ _- Liquid de th-.___�.�....:.........Capacity - s,•y Dispos Field: Distance from-nearest well.:..PQ:v- 5. --0-__-------- ' 'Dist nce from foundation._.___ _ Distance to nearest lot line � Number of lines_._._--- �___. .. Length ofleach line________� _�_._____.,__.Width of trench-_..r� {'. Type of.filter material'_- __ r_-__'De th'of,filter,material-----l__�___._____ Total length____ ___ O Seepage Pit: Distance to nearest well-----------------------Distante,from foundation--------------------Distance to nearest lot line--_____--------_ ❑ Number-of its_-"- --------. E p ----Lining material-----------------------Size: Diameter-----------------------Depth--------- --------------- P ----- Cess ool: x. Distance from nearest•wefl--_----_-____.-Distance from foundation__________________Lining material-______----_--_--_-_-__-------_____ ❑ A .. 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)_-----_--------------------------------------------------------------------------- -----------------•----------------------------------------------------------------------------------- ----------------------------------------0- ---------------•------------------•----------- ------------------•---- -----•---------------------•------------------------------------------•-----q-------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State I S, and rules and regulations of the San Joaquin Local Health District. 1 - (Signed)_---••- --�_____I_v- ------ - -- ----------------------------------------------------------------- and/or Contractor) s (Plot plan, showing size of lot, location of system in relat n to wells, buildings, etc., can.be placed on reverse side).. FOR DEPARTMENT USE ONLY 1 APPLICATIl+ON ACCEPTED BY -------------------- -------------------------------------------------------- --- DATE--- REVIEWEDBY--------------------------------- ---------- ------------- ---- ------ DATE------ ---------•---- BUILDING PERMIT ISSUED-------------------`------------ ------ DATE--------------------------------------------- Alterations ------------------_- Aaerations and/or recommendations: ------------------•-•----•----------------•--------------------------------------- ------------------------•----•----------------- ------------------------ k t ________________________________________________________________-_----_-_--__--_-_.._-.---------_----_-____-______._.____....._-.____._____.___.__.___ ---------------- --------------------------------------------------------------------+ - . --------------------- -----_ AFINAL INSPECTION BY:. -- ---- - --------------------- Date--------------------- ----------------- -------------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT .` 1601.1.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street d Stockton,California Lodi,California Manteca,California Tracy,California Wil} 99 9 REVISED S-59 3M 3-•63 F.P.CO. ]