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FOR OFFICE USE: -- ---------•------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __�l` .. _I_._ ------------------ -------- -.- ----- (Complete in Duplicate) Date Issued ---_-------_-------------_------------------------------- 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 wit County Ordinance No. 549. JOB ADDRESS AND LOCATION.. ..:3> .t_- N/( - -` l.U '` Le --------- � �,`rl✓ - srf CO - 7 wner's Name_-7 -- -----------•--"------ Phone� ------------------------ F Address......... ---------------------------------------------------------------------------------------------------------------- ------------------------------------ Z7— ----------•------------------ -- Contractor's Name__1. -e��-�. ------- !r: -,2� '��a rP �Z__ Phone Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: -1----- Number of bedrooms -,7-- Number of baths �_._ Lot size ___ __•_.._._______________________________________ Water Supply: Public<system ❑ Community system ❑ Privafefi� Depth to Water Table=-C ._ ft. Character of soil to a depth of 3 feet: 3 Sand ❑ Gravel ❑ Sandy Loam N Clay Loam ❑ Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: (If yes,date----------------_--) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No tak cesspool permitted t} dif public sewer avaiwithin lable feet.) Septic Tank; Distance from nearest eDis#anefrom foundao ---------Material---- -'-/'_�----_______________ ( No. of compartments__._-__'1________________S¢e__� �z_ f_X�dLiciuid depth____/W---...___.____Capacity-_/;-_aQ.__- Disposal Field: Distance from nearest weii"__='- __Distance from foundation---/0----------Distance to'•nearest lot line____------- [� Number of lines_____-,-9 _ ,__ __ _ ______._ __-Length of each line------�_z::"�-�__-r---_--Width of trench.__._)____________________________ Type of filter material_-_-- __Depth of.filter material____._l _______.Total length----2- f-�__�___ ---------------- 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-------------------------------------- '171 Size: Diameter----------------------------------- Depth-------------------------- ----------------------.--Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------_------------____--------------Distance.from nearest building--------------------------------- ___.________________________:=__-_____. ❑ Distance to nearest lot line------------------------- ----- ------- ------------------------------- ------------------------------------------------------------------- ' Remodeling and/or repairing (describe:_---->7-,'- c am -_. ---- ti ------------------------------------------------- c -----------------•------------------------------------------------------- ------------------------------------------------------------------------- _ --------------------------------------------.-..------------------------------------------------- ----------- ---------------------------------------- -- ---- ---- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County -h ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------•---------------------------------------- ------------- ---------------------------------------------------------------------------------(Owner and/or Contractor) By:__-./�__,_ ------------------ ----------- --- ( )---- (Plot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side}. R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � - DATE ` ----- --------------------------------- t REVIEWEDBY--------------------------------------------- ----- --------------------- ------ --------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------- -------------------------------------------------------------- DATE----- ------------------------------------------------------- Alterationsand/or recommendations:-------------------------"---------------- ------------------------•--------------------------------•-"--------------------------------------------------r---- FINAL INSPECTION BY:--- = - - -------------------- Date------ �' - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVk6ED 9.59 3M 3-'63 r.P.Cq. r