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FOR OFFICE UR; ------------------=- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No.------------------------ ------------ -- ----------.----------.------------------- (Complete in Duplicate) Date issued aa 6 This 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. l /Z — // JOB ADDRESS AND LOCATION-----p-, ------�V ....---�-------- -------------------------------------------------------------------•---------_ ------------ Owner's Name----- �/T [t- ,C� --• =`fit -� - - - ,94 ----------------- - -------- - Phone-/ " � - -Address,.-_----- -- -- ------ Contractor's Name--� .--. -----------------••------------------------------------------- ----------------------------------- ----- Phone----------------------------------- Installation will serve: Residence 0--"Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ ' Number of living units: __1___ Number of-bedrooms __ Number of baths J.___ Lot size ---- �-�-.�'�--------�--- -' --/ _ ----------------- Water Supply: Public system Community system El Private F1 Depth to Water Table &-_�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 11 i Previous Application Made: (If yes,date---------------_-._) No �ew Construction: Yes ❑ No [ FHA/VA: Yes E] Na [�r� ^' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - s Septic Ta* _.a- Distance from nearest well-________________Distance from foundation_______-____--___.Material---_---_____-_--___----__-_.__--_____________- ❑ t� r�^G' o_ of compartments------------------------- Size---- ---------------------------Liquid dept--------------------------Capacity_------------- Disposal Field: Distance from nearest well_;-7tv:77--eBistance from founclation-_ :_..._.Distance to nearest lote. _.,._.____ Number of lines_____________ _____ _________ ____Length of each line_______�j'P�__r f -Width of trench.�__y___ ____- _ Type of filter material Depth of filter material-- _ _C ._____'___Total length_--,___`1---� __.____________________ r _____Distance from foundation____________________Distance to nearest lot line______-______-_ Seepage Pit: Distance to nearest well____-_____-._ � ❑ Number of pits---------------- -__--Lining mate'ial--------__-------------Size: Diameter---------__---------.Depth_-------------_------------------ Cesspool: Distance from nearest well_________________Distance from four,dation____--___-____----.Lining material--_.__-_-_____-____-__-_____________ El Size:. Diameter ------------------------=-----------Depth-------•--------•---------NZ ____Liquid Capacity Privy: ,- Distance from nearest well__!____________________________-_:__-_______--Distance..from nearest building------------_-_______________--________- ❑ Distance to nearest lot line---------------------------------- '----------- ------------={--------•-------------------------------------=- ----------------------------- Remodeiin and or --- re airin describe r f -.. --------------------- - ------------------------ __ ------- __ ----- -------=-•-•-------•--•--------------------------•-•-----•-------------------------------------------------------- -------- 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, arW rules and regulations of the San Joaquin Local Health District. (Signed)_X--0- o"'Ir- r t-----------------------------------------------------Owner and/or Contractor) � . `- Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., (Title}________________________ i______.- _._.____-__. B I P g y g , can be placed on reverse side). FOR DEPARTMENT USE ONLY Z APPLICATION,.ACCEPTED BY----- ----- - ' Cz r �---------------------------------------- DATE------- :/__ •---�� / : ------- - ----------- REVIEWED' BY - - - - =------------------------------------ DATE------------------------ ------_------------------=------ --- BUILDING PERMIT ISSUED-----.-•-_--- ---------------------------------------------� -- ------------------- DATE-------.------------------------ -- ---------------- Alterations a /or recomtnerdations:,__-_-- � '_--___ � � � �- es ;- ---------- l -• y � — J� .; --- ------ ry'^` FINAL INSPECTION BY:.--�._`_�_.,-------r3OOWest �'-��------------ Date ._.---�---- -,----------'---- � - ------------- SAN - ------- 1 JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 3M 3-'63 F.P.CC.. t