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FOR OFFICE USE; -------------------=-------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. 1__ ._ �_.._. - -------------------------------------------------------= (Complete in Duplicate) --- --------- -- -------------------------------- `._ _-_ ._._ This permit Ex ires.l Year From Date Issuedeand Date Issued":__.__ _ �.._fa_ Application is hereby made to the San`Joaquin Local Healfh District for a permit to constal kvl,�ffct�Kerem described.This application is made in compliance with County Ordinance No. 549. L�p� : OG'J—�-f o`yq JOBADDRESS AN LOCATION.. _ - -- -- ------------ °'' `'�`" �9. �jL Owner's Name. if_ K-------�� ---------------•----------------- --------------- A _ T Address------ .�i 1 1 -3 D------ ----:5.•�:Ql��`` -tPhone ---- •-- ..... E_ LI—A Contractor's Name---------• r .P 'y= `-------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial Ely—Trailer Court ❑ Motel ❑ Other ,1 Number of living units:.---/;--- Number of bedrooms ___`___ Number o ,baths _-_f.__ Lotsize ______��''-~` '=� ------------------------- Water Supply: Public system E] Community system El.s Private epth;to Water Table --------- ft. __ � � f_J. Character of soil to a depth of 3 feet: Sand E] Gravel E]'Sandy Loam ❑ Clay Loam Clay C] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dare ---------------------1 !No ❑ New Construction: Yes.[]. No ❑ FHA./VA:..Yes,❑_j..No_❑_ _ TYPE OF INSTALLATION AND SPECIFICATIONS: - 1 (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) 4—, Se tic ank: Distance from nearest well.......... Distanc from founda ;on-_.Jr0--�-___--.Material___�a� — ---.'.__.._____. p g P` -- r- No. of compartments------7�--------- - d p. - T ----- p y-•- .. .� _.Siz_e-------x--�---_�(_ � Li uid.de th___-- -�----._._-- Ca acct �_CF_Q i Dispos Field: ,-t Distance from_nearest well__= �`.:_ Distance from foundation__.�.t?_______..__Distance to nearest lot line_ _ "rtNumber of lines---.------ �_r____�p___ Length of each line_____, -�_____��.____.Width of trench___.Z_ _,o_________________ rn Type.of filter material--__,,�_,__Lh,_____-Qepth of filter material------�_j-----------Total. length--------- -0________________;________.- Seepage Pit: Distance to nearest well-------------_--------Distance from foundation-------------.......Distance to nearest lot line____--_--_-----. ENumber-of pits.-----:---------------Lining material-----------------------Size: Diameter------------------ --_-Depth--------------------------------- a ;. " Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.-----_---_- ❑ Size: Diameter------------------------------------Dept h-------------------- ------------- - -------------Liquid Capacity---------------------------gals. i _Privy: Distance from nearest well------------ --------------------- -- ---------_Distance from nearest buiHin 9 ------------------------------ - 3 ❑ Distance to nearest lot line------------------------------------------------------------------- Remodelingand/or repairing (describe)---------- ----------------------- --------------------------------------------------------------------------------------------------------------------- e 1 _.______r________________________ ________________________________.________________._____________________...______________..____________ �! ________________________________________________________________________ ______________________________----------------------------- `1 hereby certify that I have prepared this application and that 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. -- ----------------------------------- y •and/or Contractor) �- [Signed]------------- - ---------- _ -- -- _ a - - - --------- -------- ----- t e---- - --------------- By: By•------------ •- - - - `(Plot plan, showing size of lot, location of,system in rela ion to wells, buildings, etc., can be placed on reverse side]. , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------ DATE----- ---------------------------- REVIEWEDBY-------------------------------- --------------------------------- -------------- --•--- DATE--- ----- ---------•--•----------------------------••------- BUILDING PERMIT ISSUED-------------------------------------------- ------------=-------------------------------------------- DATE--------------------- --------------------------- ---------- Alterationsand/or recommendations------------------------------------------- ------------------------------------------------------------------------ ------------••----------------------- -------------------- ---------------------- -- '-------------- -••-------- - --------------------- ------- ------ ---:---------------------------------------------------------------------- -----•-----------•-------------------------------------------------•- t ! -------------------�- -• ----------------------------------------- ---- -- --------------------------T- -------------- ----------•------------------------------ --- -------------------------------------- ---------------- ----------------+---------•- ---- - ------------ FINALi INSPECTION BY-. ate--- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F5 9 REVISED B-59 3M 3-'63 F.R.CO. k '