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l FOR OFFICE USE: ` ----------------- -=-- -p- APPLICATION FOR SANITATION PERMIT Permit No. __ ..... .. �___ _..------------------------ ----------------------- Date Issued _____ _��_._______T- (Complete in Duplicate) / �,/ ------------------------------------------------------ --- This Permit Expires i 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--------'5-Q-3---------- �� --------- --------------------------------------------- Owner's Name---- - L-------- G-... CAJUL4 � ----------- Phone-41L_C--�-`3-;-y Z---- Address-....................... ........ ........................•---------------------------------------------------------------------- Contractor's Name---------10-C�•�-�-- ----------b ,_-.- - --••---. Installation will serve: Residence Dd Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1__ Number of bedrooms ___ Number of baths ---I---- Lot size ---6O_"___.XC__.f__r -!________________________ Wafer Supply: Public system P< Community system ❑ Private ❑ Depth to Water Table -100'ft. Character of soil to a depth of 3 feet: 'Sand E] Gravel E] Sandy Loam ❑ Clay Loam El Clay El Adobe E9 Hardpan ❑ Previous Application Made: (If yes,date....................1 No,X New Construction: Yes ❑ No X FHA/VA: Yes ❑ Nog 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 _____________-_-.____.________________.____. ❑ No. of compartments--------------------- ----.Size------------------------------- Liquid depth.-------------------------Capacity---------------------- Disposal Field: Distance from nearest well`Vl,B4q-Q--+Distance from foundation____1Q...........Distance to nearest lot line-,___ --------- ® �y 4 Number of lines------------ ___ Length of each [in e----------& _____._____._.Width of trench--------2`�_..__------------ ' C �` Type of.filter material-_ R1?-cel _..__Depth of filter material-------�._e."____.._Total length_________________________�_iS,-'_------ Seepage Pit: Distance to nearest well`'Y _—___Disfanee from foundation-____1_Q%___---Distance to nearest lot line_._;__.`_---__ 161V® ' G C.Q Number of pits-----------(----------Lining material- ---_...size: Diameter--------3 "�---Depth______-------;kc-_l--------- G Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material___.__..._..___.____._.________.___. t}► + ❑ Size: Diameter----- ---------- --------------------Depth----------------------------------------------------Liquid Capacity---------------------------•gals. Privy: Distance from nearest well __________--------------------------------------Distance from nearest building__________._____________________..____._. ❑ Distance to nearest lot Vne--------------------------------------------------------------------------------------------------------------------------------------------- i Remodeling,and/or repairing (describe):____-- -.. A- _�_._. __ �f - -- ------------ ----- ------------------------------------------------------------------------------------------------------------------------------------------•--•_..._...------------------------------------------------------------ ---- ------------------------------------- ------------------------------ ------------- I hereby certify that I have prepared +his application and +hat 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) By: `-' ------------------------------- -------------------------------- -------------(Title ' - -- -- (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------------ ---------------------------------------A/V-�'------------------------------- DATE------ ----------------------------- I REVIEWEDBY--------------------------------------------- -------------------------------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------- ------------------- Alterations and/or recommendations:------- ......................... ----- - - - - --- --------------------•-•-----------------------------------•-------• --------------------- ------------------------------ -•-----•-•----------------------------------------------------------------- --------------------------------------------------------------------------------------•---- --••-•------------------------------------------------ ----------'------------------------------------------------------ ------- - - ----- --------------------------- •------------------------------------- •-------•- ------------------------- ----------------- --------- ------------- ----- -• - �� - ---- ---- ----------- - . -- k, a6 - ----------------------------------- ------- ------ ---------------------------- FINAL INSPECTION BY:- ------------------------------------ Date------- Ga✓ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California Lodi, California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.CO. 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