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FOR OFFICE USE: - ------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... -------------------- ------------------------ (Complete in Duplicate) --------------- This Permit Expires i 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. 708 ADDRESS AND LOCATION,.X-�1z <_s-- - '- -I_ W----&711-Ia ._A ------------------------------- Owner's _Owner's Name------ W7= �� t�% � ' •--- ----------------------- Phone--_-------------- --------------- Address.. . .�---. ?cam' .rf�f-- '---------------------s emc.� ------••-------------------- Contractor's Name----------------------------- to ----------------------------------------------- _ hone Installation will serve: Residence E] Apartment House E] Commercial Ll Trailer Court Motel ❑ Other El Number of living units: __. __ Number of bedrooms ---_`-- Number of baths __/___ Lot size ..___l _ rf' -�^ - ______:_________ Water Supply: Public system E] Community system ❑ Private J4 Depth to Water Table __.�__ ft. Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam D• Clay Loam E] Clay ❑ Adobe ❑ Hardpan El Previous Application Made: (If yes,date______________ } No [ p New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ; Septic Tank: Distance from nearest well___ __._._____:Distance, from foundation--'--/R240 feet.) (No septic tank or cesspool permitted if public sewer is available within p �D p_ � , -------Material------�-�--+'('-?-----=------------�--- ------� [ No. of compartments-.----_�- ------------Size_�XJU--------.---Liquid depth----- ----------;Capacity- -1' -"------ Disp_osal Field: Distance from nearest well--- -----Distance from foundation---� ---------Distance to nearest lot Number of lines-------/---------- Length of each lin..........60- -- --------Width of trench.------ --�----------------- IV Type of filter material__2l_l 1 ______Depth of filter material_r2 __-, Total length---------lo_Q--._-__-- Seepage Pit: Distance to nearest well-.____---__- -------Distance from foundation--------------------Distance to nearest lot line------------------ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth---------------------__---------- 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 ____.----------------------------------- F1 _______-_ ___________ _---._❑ Distance to nearest lot line -------------------- ------------- ------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe):-: .4.i-.._____ - '�-_._ - _�c� ----- ----- '. ------- --¢ _ ,Q( s�C.�.Z__i _ .�________� ._ ------ I hereby certify that I have prepareY9 th`Is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatiogs of the San Joaquin Local Health District. ----- - ! --------------------------------------------------•-------------------(Owner and/or Contractor)(Signed)--a- _ 1 _Z& tBy� --------------•--......------------•---------------------------------------------------- {Title(-------------------------------- �> (Plot plan, owing 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------------------------------------------------------------ REVIEWED BY----------------------------------------------------------- -------- ----- -� -, cC- - ----------------- --- BUILDINGPERMIT ISSUED------------------------------------ ' --------------------------------------- DATE----------------- --------------------------------- Alterations and/or --------�-�--=lLp�' r-fe„c^oc_mmaeCPnc,d�La!atutZio.-nfs�:°_-_--------�� _l�_t.:.5k.... � __i_1_ ` ________•_'__.`_�_ __ -- -- -- --- ------------------ -------------- -------- ----- ----- �`y - , 1 - ------------•----------------------------------------------------------------------------------------------------------- --- ------------------- -------------------------------- FINAL INSPECTION BY:. - - - . ---•------------- ---------------- w ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecor California Tracy,California EB 9 REVISED B-59 3M 3-'63 F.P.CD. �M