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FOR OFFICE USE: N ---------- ...==--- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ." _. � f----- - (Complete in Duplicate) 4 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. tO ` JOB ADDRESS AND OCATION ----------- )--t-- _---.- -�-------------=---------------------- s•i Owner's Name----- rr --------------------------------------------------------- ----- L- .._ Address----_----------------- -- - -------- --•- • ---................:.---------- ------.-.._..----------------------------------------------------------------------••--- ........ v Q Contractors Name-------f---- --- ••----- --- .--------•- - -• -----••-----= ----- - ------------------_-�_ .._.------------------ Phone..•�:�-�•-��--(--�-�-� Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]- Number of living units: __{_____ Number of bedrooms _ '._ Number of baths ....I--- Lot size ___//___AA�5""+.._?C."""_I-SP_'_______---------- Water Supply: Public'system E] Community system ❑ Private Depth to Water Table _fes'- ft. Character of soil to a depth of 3 feet: .' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [3 Previous Application Made: '(If yes,date_.__ ,_...._ .I No144 New Construction: Yes E] NoA FHA/VA: Yes E-] NoX # 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--y----------------------size---------------- -*------:_._Liquid depa h--------------------------Capacity------------•-------•-- Disposal FielcL Distance from nearest well..... Distance from foundation-----/_0_____.___Distance to nearest lot line_ ___.__-_. Number of lines--------------1._`------_-------Length of each-line__________--- . ` Width of trench-----._--Z Type of filter_material__-S_-Aero/LDepth of filter material.......... '-_._Total length------------------------___________-_____ J Seepag Pit: Distance to nearest. --------Distance fro foundation-------- ___.Distance to nearest lot line____ -------- rxNumber of pits___.__�______________Lining matenal_ -_ ' Size: Diameter_____- __._.___.Depth___________2" ____.___.__ 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_`______________________--.,._-._._ 9 ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------=-------------------------------------------------- 1 Remodeling and/or repairing (describe):---------t � _____ - -rF_ F.n,,.�,___ ------------------------------------- •---------------------•-----•------ --------------------•-----•--------------------==-----•------------- ----------------------------------- -------------------------------- --------------•--------------------------------------- -----------------------------------------•-.----- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- I hereby:certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc 5, State laws, and rules and regulations of the San Joaquin Local Health District. - r - (Signed)-------�. = - ------- --------------------------------=----------------------------- (O ner and/or Contractorl BY ----- ` --------(Title)- ------------ ------------------- (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side)., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-;----- "-- �G4` ------------------------------------------------------------- DATE------ REVIEWEDBY-------------------------------------------------------=--------- •-----••------•-------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------- a� = ----- DAT ------- Alterations and/or recommendations:.____a �3�_. y/._-____ _ r _ _ _ ' _ f ------------ -------------------------------------------------------------------- - ----- _..._� ---------------------------.------- CTION - --FINAL INSPEDate----------- SAN JOAQUIN LOCAL HEALTH DISTRICT tt`$ , „ 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CC 9 REVISED 5-59 3M 3-'63 r.p.Ca, r \ �