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OR OFFICE USE: "fir y� I --------------- / APPLICATION FOR SANITATION PERMIT Permit No. ._/�.....D ---------- -------------------------------------------- ------- ----------- (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 with County Ordinance No. 549. JOBADDRESS AND LOCATION....__ Z �------- - f• ------ --------------------------------------- -------------------------- Owner's Name-----��--�"'----------------��•1`�'_rr._ ------------------------------- --- ------ Phone__ .________�___ Address------------- ........4- --------- ---------------_----------------------------------------------------------------------------------- _-_-.-------------------------------------------- Contractor's Name----- ` f ,5 .7j,-I------- --------------•------------------------••--- ---•------------- Phone----_---------------------•------ Installation will serve: Residence 0' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/____ Number of bedrooms __Z__ Number of baths _-/_.. Lot size -------S12--X-1A0--------------------------•- Water Supply: Public system Rr 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& Hardpan [❑ Previous Application Made: (If yes,date-------------- ] No [E- New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No H- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-Al Distance from founclation_ --------Material----__________________________________---.____. No. of compartments--------------------------Size -------------------------------Liquid dep? h------------ ------------Capacity-----------•• ------ Disposal Field: Distance from nearest well Distance from foundation../-Q-�__---__.Distance to nearest lot line----d`�.......... ®r Number of lines.--------/------------------------Length'of each linerfr�T�-- �f-----Width of trench------ ---------. -,W--------r Type of filter material_W-a_G-A-------Depth of filter material___ -..-_____„Total length________`_)___ °_ � _ Seepage Pit: Distance to nearest ____Distance from foundation___ P----------Distance to nearest lot line__IKr e - Number q{pits--------/------------Lining materlaL_�u�_k-----Size: Diameter___+�.3.............Depth-th- - ZA -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------_----_____--___.____________ M ize: Diameter------- Depth---------------------------`- ----------------_-----Liquid Capacity---------------- ---------gals. Privy: Distance from nea I-urs________________________________________________Distance from nearest building-g--- ------------------------------- I� ❑ Distance to nearest lot line-------- ------------ ' ,f i Remodeling and/or repairing (describe):---------------------------------------.- ------------ 5 ------•----------------- - -----•---------------•----------------••---------------- e ----------------------------------------------••---------•-•--------•-•--- ..._ -------------------- ------------------------------------------------------------- ------------------ - `. ---------------------------------------I-------------------------- --•------------------------•---------------------," ------------------------------------------ - ••- -- - ----------------------------- 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 relation f 2en Joaquin Local Health District. _qy(Signed)--------- r (Owner and/or Contractor) ---------------------- ------ --------------------------- By:------ ........ � --------------------- l------------------------(Title)---------------------------------------- ....... ------------- (Plot plan, showing size.of lot, location of-system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ---------- ------G2�^---------------------------------------------- DATE------ -�----�----------- REVIEWEDBY.-------------------------------------------- ------------- -------------------------------------------------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----- ------ DATE-----------------------------------------x----------------- Alterat'ons and/or recommendations.----------- ---- ------- - "ra y=�� ._�_._�_t-_t_=---=,1--...-/ ` --7�- 6 - - - _...... :-: Ce-------- % ---------------------------•--••-- -------------------------------------------------------------------------- -C----------------•------------------ ----------------------------- m ----------------------------------------------------------------------- ------------------ ------ --------------------------------------------------------- ------------------------------- - - ------------------------------------------ -----------------------I--------------------- •----------------------------------- FINAL INSPECTION BY:...... ------------ ------------- --- Date ` USAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street , 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-•fi3 F.P.CC. c i l � Y