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1-UK Ul'h(_L USt: J = _ 19 ----------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... -------------------------- ----------------------------- (Complete in Duplicate} ------------ - This Permit Expires 1 Year From Date Issued Date Issued _.�a�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and�all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANP LOCATION-., +r �tAl"-----------'------ --------------------- --------- _ Owner's Name----- ------ •�.-------•- aov- -- --- -------- Phone------------------------------------ Address----------------IV- ----------•--------Address----------------- - ..-.. Contractor's Name---- i ------------------------------------------------------ Phone Installation will serve: Residence T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: -1----- Number of bedrooms �---- Number of baths J_._ Lot size ---------1_l��_ __--- Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table 4-7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam rk] Clay Q Adobe ❑ Hardpan Previous Application Made: (If yes,date____________________) No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi alrjc: Distance from nearest well-----------------Distance from foundation________________--.Material ____._____________________.________--_____-__-.. No. of compartments---------------------- --Size--------------------------------Liquid depth--------------------- ---Capacity----------•--------- isposal Field: Distance from nearest well-A.-P-------Distance from foundation---Z®*---------Distance to nearest lot line_�S-_�_..__... Number of lines------/---------______ Length of each line__/4!-_________--_.Width of trench--- -�'.___trench--- --------------------- Type _______ .- Type of filter materiaj _� Depth of filter material___j_ L.---------Total length---/-7 --!------------- - ---------- Seepage Pit: Distance to nearest well-f '------_--Distance from foundation-__4 .........Distance to nearest lot line.!�711---------- ,l1 --------.Size: Diameter---_a-34---------De th- J Number of pits-_.1______________Lining material p a-S�-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_._._-----...___._..________.____--. ❑ Size; Diameter------------------------------------ Depth----------- ---------------------------------------Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well--------------------------------------------.----Distance from nearest building----------------------------------------- El ,..___-_------_______ --_ - ❑ Distance to nearest lot fire---•------------- �. Remodeling and/or repairing (describe)------------------------------------------------•------------------------------------------------------ -- u l ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- -------------------------------------------------------------•------------------------------------•---------------------------••-------------------------------------------------------------------------------- -----------------------------------------••-----------------------•---------------.--..---------------------------------------------------------------------------------------------------- I 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. r, ro (Signed)--JAA- ls- ---- - ------------------------------ -- ---- -------------------- -- - -(Owner and/or Contractors '1 By:---------------------------------------------------------------------------- --------------------------------------------------- -----(Title)------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, ercc.;can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 7 BY_ _ et ______----------------------------------- ,�.I' DATEDATE ------------ ----------------- REVIEWED BY --------- ---------------------------------------------------------- ---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- ----------------------------- Alterations and/or recommendations:---------- ----------------------- ----- ---------------------------------•----------------------------------------------------------- --------------------•----------- --------------------------------------------------------------------------------------------------------------------•------------------------• -•------------------------------- --•--------------•------------------------ -------------------------------------------------------------------------------------------------------------•--------..-------------------------------------- FINAL INSPECTION BY:_ ---------- Date---.(�..' ~� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore street .205 West 91h Street Stockton,California Lodi,California Manteca,California Trocy,California E9 9 REVISED B-59 3M 3-'63 F.F.CD.