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FOR OFFICE USE: ------------------------------ -------------------------- i _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ------1—-------�5 . -------------------------- ---------------------------- (Complete in Duplicate) This Permit Ex fres 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 herein described. This application is made in compliance wit County Ordinance No. 549. JOB ADDRESS AND ATION----- -__ _G(1P� .•---- --C ►:�-f---- t`D-E� f�---�� ------- Owner's Name----- ,f tC1i1- ._ 1 ,��J'r PhonelP/ ._7. .. ._-. � Address p-- �R Q > (�!� ---- .................. •- ,, /gyp /_�/ Contractor's Name �� „ f[l.._L.� ` e 7 --------•--------------•---------:---•--•--•- Phon _!� Tll1. Installation will serve: Residence ❑ Apartment House ❑ Commercial P0 Trailer Court ❑ Motel El Other [INumber of living units: __----- Number of bedrooms ________ Number of baths -------- Lot size __ - ________________________ Water Supply: Public system 5( Community system ElPrivate E] Depth to Water Table !J - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No X New Construction: Yes ❑ No 5( FHA/VA: Yes ❑ NoA� TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) �.. Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------..--__-._._.________._.__________.___.___. t ❑9CiS-h►v6 No. of compartments-- -----------------------Size---------------- ---------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well________________Distance from foundation-----...............Distance to nearest lot line................ ❑'ZK15-�N9 Number of lines-----------•-----------------------Length of each line------------------------------Width of trench-------•--------------------------- Type of filter material-------------------_-----Depth of filter material-----------------------Total length___________-_-_---___________-______.___-- Seepage Pit: Distance to nearest well_ _ OAVE,__----Distance from foundation_--S.Q__.-------Distance to nearest lot line.10_ Number of pits.06) C{— Z Lining material---UC -------Size: Diameter---.__ __._._ � tr Depth ------- i J Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material---------, ,a _-_--------------- ❑ Size. Diameter--------------------------------------Depth-------- -------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________ _ _____ ___-____._______-------Distance from nearest building------------------------------------------ ❑ line—.--- _ __ Distance to nearest lot line ----------------17----•- ----------•-•-•--------------------------------•-•-------------------- Remodeling and/or repairing (describe):__-- _ --_.. .. •-------__ -- -------------------- _) ---.---- ----------- ---------------- ------------------- •----------------------------------------- ! _. ---- -- .--- ---------- • ---------------- v --- ..---------------- - ----------------------•--------------------------------------------------------------------------------------- --------••- ------ I hereby certify that I have prepared t ' application and + at the work wi be done in accordance with San Joaquin County ordinances, State laws, an ules and re a ons of the San Joaquin Local Health District. (Signed) . ------- ------------ (Owner and/or Contractor) iBy:-------------------------------- "�`�----��---- --- --------- -----�G-------------------(Title)-- _ c.L?�C�d---------------- - -- -------------- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be pia don reverse side).` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / = -----------------------------•------------- •---------- DATE----�-{--------------- REVIEWEDBY------------------------ ---------- --------------------------------------------------------------------------------• DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------._. DATE-------------------------------------- Alterationsand/or recommendations:--------------------------------------------------- --•----------------------------------------...._-_.._._....----------------....-..--------------------._... -----------------------------------------------------•-------------------------------------------.--------------------------------------------------------------..---- ------------------------------ t -----•------------------------------ -------------------------------------------------------------------------------------------------------------------------------------•••--------•--------------------------------------- - ------------------------------------------------------------------------------------------------------------------------ FINAL 'INSPECTIONBY: - _ ------------------•-- -- Date----- -" -� '- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVISED 8-54 r.P.CD.2M 6.60