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FOR OFFICE SE: -_ APPLICATION FOR SANITATION PERMIT Permit No. •_•.................... ----------- ------------ -------- (Complete in Duplicate) - 2 7- Date Issued ______________________ _________________ ----------------- This Permit_Expires /_Year From Date Issued_ s 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. y��} f� q_t021(}--13 JOB ADDRESS AND LOCATION/Pe---- - 1..- 815__--- _--- i q1101 ------------ �. �Q 4 Owner's Nam ------•-------------------- -- ----------•-••--•---------------------- - ------------------------------------ Phone-- ••--------------------------•--- Address--------93------zo .... . ----- t ----------•-------------------------------_-.--L------------------------------------------------------------------------------------------ Contractor's Name--------- ----------------Y-.-� ------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence;U3'"-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.;_-f--. Number of bedrooms ._3__ Number of baths _/----- Lot size _ _f _____________________________________ s Water Supply: Public system ❑ Community system ❑ Private 9i'Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: (If yes,date---------------- ---) No-®-- New Construction: Yes fflNo ❑ FHA/VA: Yes ❑ No [LRS TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-.45 ____--Distance from foundation__--�_.____.___-.Material____!_`"`_______________________________. No. of compartments----±2-----------------Size------ Liquid depth---._"..`.___.----------Capacity.... �Qp i ._r Disposal Field: Distance from nearest well.�V-------Distance from foundation---11�___, 15-_.-_-_...Distance to nearest lot line..- ____..._. 4 Number of lines______. _ -____--_Length of each line-_7-'__________�-,_:.Width of trench__-�$_!`'________ _________ Type of filter material---__.Q_G_�--------Depth of filter material---11-----------Total length___.___�'_SQ__�_�__�___---_* ��_ Seepa Pit: Distance to nearest well---/aA----------- Distance from foundation__7A_~_______.Distance to nearest lot line_S�_______ T E Number of pits_____ ______ ___ _ �,. _ _ Lining material--�os✓�----..Size: Diameter_-��-�--------.Depth---- - Sr----------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------___ --------------------- ❑ Size: Diameter------------------------ Depth---- ----------------------------------------------Liquid Capacity-------------------------...gals. 'T Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building-------------------------------__--__..__- [] Distance to nearest lot line------------------------------------------ --------------------------------------•------------------------------------- ------- Remodeling and/or repairing (describe):-------------------- ---------------------------------..-_----------------------------------•---------------------------------------•---------------- Ro -----------•-------••-----------------------------------------------------•----------------------------------•--------------------------------------------------------------------------------------------------------------- ------------------------------------------------------•---•-----------------•---- ------------------------------•------------------------------•--•--••------•---------------------------------------------------------- ---- ------------------------------------ -- ------------------------------•--------------------------------------------------------------------------------------------------_-------------------------------------------------- pr I Hereby certify that 1 have prepared is appl' ation and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ations the San Joaquin Local Health District. (Signed)---- -_-------------------- -- ---------------- -------- ---------- -------------------------------•-- ---------------------------------------------(Owner and/or Contractor) By: (Title)-- Y• -- -- . ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------Li._..---- - --- ------------- ----------• ---------------------------- DATE--------- ..- zit^---•--------------- REVIEWEDBY---------------------------------------- ------------------------------------------------------------------------- ......... DATE------------------------------------ BUILDINGPERMIT ISSUED------------- --------------------------------- DATE------------------- ----- ---------------------------------- , 1 h ._ Alterations and/or recommendations:____../___-.Z-_--__.._. _ ___-_f ^L T- ` `ifs [_'_- -. =GL-----, � --- -------------- -''` - ---------------- (�-------------------------------------------------------------------------------------------------------------------------------------------------- ---------- --------------------------------------------•-•• ---- ----- ----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------ -------------------- ------------------------------•----------------- -----------------------------••----- - FINAL INSPECTION BY----------- - ----------- ----��'"L_. -- Date------ --.-- s - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,Callfernia Lodi,California Manteca,California TrFy,California ES 9 REVISED 8-59 3M 3-•63 F.P.CO.