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FOR OFFICE USE: \ -------------- Permit No. APPLICATION FOR SANITATION PERMIT \ ------------------------------------------- ,f -" -------------------- ------------------------------------ (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. JOB ADDRESS AND LOCATION.. CL_ ....... =`' =- ._LC �..P J ------------------ it c Owner's Name � ' ' ----Cry-�i-�a- - Phone Address------ ------- ---•- 1 ------------ Contractor's Name---------------- --- --------- ---------------------------------------------------------- ---------------- Phone-------------------1 ------- Installation ---I-Installation will serve: Residence ❑ partment House ❑ Commercial [-] Trailer Court [jMotel [] Other Lh�' � Number of living units: j_____ Number of bedrooms --------- Number of baths f------ Lot sizeJ-�_--�_______________________1 ---- ZAP Water Supply: Public system ❑ Community system ❑ Private [,,,/,Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan Previous Application Made: (If yes,date-----------._____._J 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.) --- / N- �f J Se tic Tank: Distance from nearest well---.C_d�"9____Distan from f�undat,ion-----______________-Mater al-___ �_ _____.__-�:__W___.._..___._---_. No, of compartments-------" _.____---.-.Size_ j _/_� ALiquid depth___._.___. Capacity____ ___ pis o al Field: Distance from nearest wellM.O-_M. --Distance from foundation-----777x__._-----Distance to nearest lot liry_____�r�_____ Number of lines___�- ___Length of each line____. _�___�__ ___ �� ---Width of trench-�--�---------------------� Type of filter material _ _CI%tt-Depth of filter material----.---�__9-_`_r.Total length---------- _ ___C�_____________- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_______.--.___-_ ❑ Number of pits----------------------Lining material-----------------.-----Size: Diameter-----------------------Depth--------------------------------. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-..._-__...._______.___________ _ ❑ Size: Diameter---------------------------- --------Depth---------------------------------- -----------------Liquid Capacity- - ----------------------- gals` Privyt� Distance from nearest well_______________________ _Distance from nearest building______-_______________________.._ ---- ❑ Distance to nearest lot line--------------------------=------ ---------------------------------------•-------------------------------------------------------------- - Remodelingnd/or rep airi (describe)---- ---------------------------------- ------------------------------------------------------------------------------------------------------------------ ---------•• ----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------I------- ----------I------------------------------------- ------------------------------------------------------------•---------------------------------------------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+a-je flaws, and rules and regulations of the San Joaquin Local Health District. Signed)---- ------ ----------- ----------------------__.__.Owner and/or Contractor) Bye.......------------------------------------------------------------- ---------------------------------------------------------(Title)- ---------------------------- ------ -- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- ------------------------------------------- ATE------------------------- --- ----------- ----------- REVIEWED BY------------------------------------- ------------------ ------- - -- --- DATE1-� - = -------------------- BUILDING PERMIT ISSUED------------- ----------------- ----- --- �- DATE---------------- -------------------------------------- Alterations and/or recommendations------- ------ --------------' -- ----------------- ----------------------------------------------------------------------------------------------------------------- -----------------•--- ---------------- -------------•--------------------- --------------------------- ------------- -----------------------------------I---------------------------•-------------------------- -------------------------------------------------------- ------------------- -------- !`-1 L� - �------------ bate FINAL INSPECTION BY:...-------- -- n ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F-P.CC.