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FOR OFFICE USE: t � �.p ------- --- --------------------------------------------- APPLICATION_FOR_SANITATION PERMIT Permit No. ------------------------- ----------- [Complete in Duplicate] Date issued ---------------------------------------------------°__' Tllis 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. 549. JOB ADDRESS AND LOCATION 'l1-- -�(- 1 /t - /___" Owner's Name _f2. 1tf P_ C .I"1� Y..= /�- ----------- Phbfie`, �D1I�,�1 Address - _ X---`��---'-��-------- •%-�•Cf L� -------•-----------------------••-•------------------------ Contractor's Name------------------------------------ 1 .� ......------------r---••---------•----•----------------------•- --•-•------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel L] Other E]Number of living units: ___�__ Number of bedrooms Number of baths __�____ Lot size ____-_-_.1 � -------- ---------- Water Supply: Public system ❑. Community system ❑ Private Or'Depth to WaterryTable-�ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravely❑ Sandy.Loam ❑ Clay Loam E] Clay ❑ Adobe M--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 02-"New Construction: Yes 2,`�No ❑ FHA/VA: Yes ❑ No U�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well________________ Distance--from foundation__-_______--_'___-.Material ___---__".____-__.________"__.________.-______. ❑ No, of compartments--------------------- ----Size_ _1...... ------------Liquid depth__.---------.-------------Capacity Disposal Feld: Distance from nearest well"_J _4- Distance from foundation__Z19 " "".Distance to nearest lot line---cS____29-". [ Number of lines______________ 1Length of each line----------16& Width of french.........� _____-__.____-_- T�------ Type of filter material_- -- �_ __ epth of filter material______ __. -_"_Total length--------LlAJ______________________. Seepage Pit: Distance to nearest well----------------------Distance from foundation---.................Distance to nearest lot line__-_____-_______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---- ------Depth----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation____--------- ------Lining material-___________-_____________---------- Vl ElSize: Diameter----:- ---------------------------Depth---------------:------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distarice.from,nearest building.--___-_______________---_____.____._____- ❑ k Distance to nearest lot line--- --------------------------------------------------------------------------------------------------- ----- --•----------------------- � Remodeling and/or repairing escribeJ - "• razz ---�_,-.,----- --------------•----------------------- --------------------------- ------------ ---------�----- y -----------•--------------------------- -{------ =----------------------------------------- ----------------- ------------------------------------------------------------------------------------------- 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 of the San Joaquin'Local Health District. (Signed) _ ------------------------- ------------------------------------- - (Owner and/or Contractor) r � K -= ^------- ------------------ -------------------------- (Title ) (Plot plan, showing size of lot„locationT of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- �-� --- DATE------- J- REVIEWEDBY Y ------------ ---------------------------------- ------------------------------------------- DATE------------------ •------------------------------------- BUILDING:PERK 1T ISSUED------- = TE------! - ------- -- Alt to d/or recommendations: '+-�'` " - ` _ � sI . -- - ------r---------- -- --- - ------- - --- -c---- _-'-r '' - - ------- ------- ------------ r--------------------------------------------- ----------------------------- ---------- --=------- ----- - -- ------- -- -------------- i--------- , ,� # rt . FINAL INSPECTION BY:--- ....... --------- - -- `' Date - - SAN JOAQUIN�LOCAL�HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 2.59 3M 3-'63 F.P.CO. t