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FOR OFFICE USE: / �, Permit No. APPLICATION FOR"'SANITATION p�RM1T ----------------------------------- ------ --- - --------- (Complete in Duplicate) Date Issued ----------- ----.. ------- --- -_-__ --- This Permit Ex Tres 1 Year From Date Is ------- sue ll Application is hereby made to the San Joaquin Local Health District for a permit to construct S�U�ns+ U}h rk herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ f./ " SD - -- rj Phone. Owner's Name d -- �'� -----1_ _} , j ----------------------------------------------------- Address------- Address-----•-- --�--- • 3 --••------ t ------------- Phone Contractor's Name------ .._-4.... T�-- ---� Installation will serve: Residence ❑ Apartment House [I Commercial 0 Trailer Court ❑ Mote ❑ Other ❑ - --- ----- -- Number of living units: ------- Number of bedrooms __------ Number of baths -------- Lot size _ ------ --_ Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Table CO- ft. Adobe Hardpa Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam ❑ y ❑FF{A/VA: Yes [I No Previous Application Made: (If yes,date--------------------) No o New Construction: ,Ye No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: m (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� Septic Tan Distance from nearest well-- Distance from foundation-------------------.Material------------------------------------------------- Septic -.--__--_---.---------.------------------ - No. of compartments-----------------------j--Size--------------------------------Liquid depth-- Capacity U Distance from foundation_---- .490 Distance to nearest lot line-- --_-----.. isposal Fiel Distance from nearest well--- f r Number of lines--�. --- ------- -----Length of each line---�Q.-----------------Width of trench----I-0-1--.--------------------- De Depth of filter material---.�--- -_ -,.-Total length---- ---------------------------- Type of filter matenal_ -- p �` 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--_---------------------------9 els. F-1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- - - Distance from nearest building---------------------------------------- Privy: Distance from nearest well--------------------------------- ❑ Distance to nearest lot line----------------------------------------------------- Remodeling and/or repairing (describe):-------. — ----------------------- ------------------------ ----------- -- - --- ------------------------------- -------------------------------------------------•------------------------- -------------------------------------•----- ---------------------- - - - I here y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinac S a aws, an rules :and egulations of +he San Joaquin Local Health District. n wner and/or Contractor) (Signed)--- -----�-------------------�------- ------ - -- ------ ----�- -------- ---- --- ------ ------------------------------(Title)-- --------- -------- ---- [Plot plan, showing size of lot, location of system in relation we11s, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY DATE------------------- -------------------------------------- APPL1CATlON ACCEPTED BY------------------ -------------------- --------- ---------------------•---------- --------- DATE- --7-1-L-7-6 --- --- ----- --------- REVIEWED BY ----------------- DATE----------------- - ---------------------- BUILDING PERMIT ISSUED------------------------------------------------------------•- - --------------------------------- Alterations and/or recommendations:----------------------------- --------------------------------------------=--- --------- ------------------------ - ------------------------------------------ -- -- .--- -------------_-;-----_-7---------------------1---------------6-------------------------------- ---------------- ------------- - FINAL INSPECTION BY------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantem,California Tracy,California ES 9 REVLSED 8-59 3M 3-'63 F-P.CD. ,f 9