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FOR OFFICE USE: 4j, -------- .. �_ ° ' I Q APPLICATION FOR SANITATION PERMIT Permit No. ... ------------------------------------------------------- (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued Da+e 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._N549. JOB d ADDRESS AND OCATION.!_O-GS�----------_------- ------ - --- -- ��------•-- --------------- --------•------------------ Owners Name < *7 -- -- Phone = _ --- +E Address-----•-------------------=--- ---- --------- ......... -- ---� - ------------------------------------------------------------------•------------•--•-•------ Contractor's Name l- - • - --•-- �� ----------- ------------ ------------------------------------------- Phone----------------------------------- Installation will serve. Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -I____ Number of bedrooms __I___ Number of baths ---/-- Lot size ------- D_"_- ___ ®.________________ Wafer SuPP!Y� Public.system Community system Private Depth to Water Table,`_ ft. ' I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5d Hardpan ❑ Previous Application Made: (If yes,dote______________.__-1 No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted ifsewer is available within 200 feet.) t /d Septic Tank: Distance from nearest well�huon,,.Cel__ Distance from foundation- Q"_.""_"-""".Material___ �_`_____�'"____________ No, of compartments---GZ__________________Size5- ------I____Liquid depth-_'--/___-----------------Capacity.go?_ __- Disposal Field: Distance from nearest well? 42L&Distance from foundation___v�__4.......Distance to nearest lot line_______..__T Number of lines--------I_-_=Z=______•---- _ Length of each line_-_--_1Kd__-___-��___._.Width of trench___._____�.1�'_�__�-_____"�___ � Type of filter material___z __$�1 epth of filter material----/X'.,--------Total length_-__---._-__-___---____�Q..___ 00 Seepage Pit: Distance to nearest well-�zllY_4k_____Distance m f undation___. Q.___-_.Distance to nearest lot line-___ __--._ U ____Size: Diameter.____ '� . (� Number of pits-----/---------------Lining material- - - --- - ��- - Depth-------•c�---------------------- # Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material____.____._____.__.-_--___-____---_-. ❑ iSize Diameter-----.-___---__-_---__--__________�_Depth '-----Liquid Capacity gals, , Privy: f Distance from nearest well------------------------------------------------- from nearest building---------------------------------------- 7 pDistance to nearest lot line------- --------------------------------------- ------------------------------------------------------------------------------------------- Remodeling and/or repair:ng (describe):-------------- ------------------------------------"----------------------------- ----•--------------------------------------------------• 1! 1 � + ------------------------------"-----------------------------------------------------------.._...-.....---------------------------------------•-------------------------------------------------------------------------------- I hereby cer 'fry that I have prepared this application-and that the work will be done in accordance with San Joaquin Counfy ordinance$, St a laws, and rules an regulations of the San Joaquin Local Health District. Si ned -I ----------------- .-._ Owner and/or Contractor} ( 9 } By:._...__._.-__•`------------------------------------------- -- ---------------(Title) �------- (Plot plan, showing size of lot, location of system in relation to well uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----C_ `o$32-5-- ------------------------------------------------------------------ DATE.---4'- !4 4----------------------------- REVIEWED BY-------------------------------< --------------------------------- --------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--- wt--:----- R.S �_..-r a._---- ` i.-- _ - --------------------- -- ---------------- ------ ----------------- ------------------`- --------------------------------------- ------------ ---------------- ----------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------------- ------------------------------------------------------------- ---------- ---------------------------------------------------------------- FINAL INSPECTION BY:----(-'�5----------------------------------- Date ------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slotlrton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 9-59 31A 3-'63 F.P.CD.