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'/FOR OFFICE USE: i�1-�f- /----- --- ---- -- ------1_3.9. ------------------------------ --------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------ -------- (Complete in Duplicate) --.-.---.-__ This permit Expires 1 Year From Date Issued 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__3-3 -5 �� Owner's Name------- --------- -- lZ.e Address------------- -----------------------------------•-•--•------------------------------------------- Contractor's Name---�,.�--�-- 4�•----------------------------------------------------------------- Phone---------------------•- Installation will serve: Residence ''] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other EI Number of living units: -------- Number of bedrooms _J--- Number of baths I___ Lot size ---- ---6C_- -G_______________________._ Water Supply: Public system 14 Community system ❑ Private ❑ Depth to Water Table ------- ft. 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 X 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.) Septic Tank: Distance from nearest well------____-------Distance from foundation--------------------Material------------------------------------------------ . No. of compartments--------------- ----------Size-----••-------------------------Liquid depth---------------- ---------Capacity---------------------- Disp sal He Distance from nearest well-----------------Distance from foundation_____.___________-Distance to nearest lot line_______.._-_..._. Number of lines-------I-----_ __________________Length of each line------3_�3--.___��______-Width of trench__-_�f�.____-__-________ w CA—dP" Type of filter material____ �_�--__Depth of filter material___.-_'.7__-____-_--Total length---------`1--c_________________________ t Seepage Pit: Distance to nearest we11��1 4_'+��_-Distance fromfoundation-----�41_________.Distance to nearest lot li ne__.S_-_-__-. � Number of pits-------/-------------Lining material-----------------------Size: Diameter.-7-3-- ------Dept ------------------ W Cesspool: Distance from nearest well-______________Distance from foundation--------------------Lining material------------------------.______-____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------r-------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-__-__-__._______________-__.-____... ❑ Distance to nearest lot line----------------------------- ------------------•---------•--------••---------------------------------------------------------- ® c�.� 4)- -- '. Remodeling and/or repairing (describe): �'�- —�' ---------- -- --------•.- - -- -----y-^-----------------------•------------------------------------------------------------------- ---------------- ---------------- ----------•-----••----------------•--------------•-----------•---------------------------------------------------------------------------------------------;r---------------------------- 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. (Signe4)( - j- ----- ------------------------------------------------------------------------------(Owner and/or Contractor) By --------- (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- - ----- - -------- ------------------------------------------------ DATE--- - - ----------------------- REVIEWEDBY-------- ---------------------------- --------------------------------------------------------------------------------------- DATE--- ---- --- ------------- -------------------- BUILDING ------------------- BUILDINGPERMIT 1SSU ED-------------- --------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--a_:.. ,,� --------------------------------------- ---------it_ ---- ------ ----------•----------•--••---•--------------------------•----•--•------------•-- r ------36----- �� ------- l�=�� -------------- ------------------- --------------------------------------------------------------------------- --------------------------------------------- -- - ------------------- Date__.. '-/--7.- -�K--.-...---------------- - FINAL INSPECTION BY:_._-G.'. _ --,--_-------------- - - - ------__-_-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F5 9 REVl3 ED 8-59 3M 3-'63 F.P.CC. = -