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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -1. _�_- .-_.. ------------- --------------------- ------------- ------------------------------------- ------------ ------ Complete in Duplicate) Date Issued --- ---------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a perm' tofcBnstruct an instal e work herein d scribed..y,, This application is made in compliance with Cou ty Ordinance No. 549. '/ f,l {� �/ JOB ADDRESS LOCATI N_ =�C G - Owner's Name--- o--to-_•- ---•-- ----------------------------------------------- ----------------------------------- -- Phone4/462_- 5R�-�-- - --- Address� _ Or--: ..-d •-•--•----- .... _ ------------------------ Contractor's ---------•------------Contractor's NamJ/�--� I'^r• s Q' �' `'� Phone6-i _ � Installation will serve: Residence [ par m nt House ❑ ommercial ❑ Troller Court ❑ Motel ❑ Other ❑ Number of living units: --'-_-_ Number of bedrooms _lumber of aths -1_-_ Lot size .--_ - -------- -- ----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table --- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previods Application Made: {lf yes,dote--------------------) No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if public sewer is available within 200 feet.) f r Septic Tank: Distance from nearest well ,5-0..f-----Distance from faun ation---�_ ----.--Material___+ -----------. No. of compartments--- -----.-__�Size � l _--Liquid d`pth-- -.�1- Capacity----� -------- Disposal --_---_ Dis os I Field: Distance from near well.��-----Distance from foundation----Qom_----Distance to nearest lot lin`-4-9-0_. Number of lines__-._-_-_ - Length of each line---- --- __ Width of trench.___-�` ------------------- Type of filter material - Depth of filter material---- -��----.---Total length___.-----__-----:-_/0-0_�--._--. ---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--.-----_-------- 7 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth--------------------------------_ S 'I Cesspool: Distance from nearest well-------- ------Distance from foundation--------------------Lining material-_.--__-.---.----.-----__----_---.. ❑ Size: Diameter--------------------------------------Depth-------------------•- ------------------------ ---Liquid Capacity-. .-----------------------.gals- f Privy: Distance from nearest well---------------- from nearest building------------------------------------------ P ❑ Distance to nearest lot line------------------- -- ----------------------- ----------------------- -------------------------------------------------------------- ----- 3 Remodeling and/or repairing (describe)-------------- -------------- - - --------•------------------ -----------••--------- -----------------------• ------------------------------- ---aL - -------•--------------------------------- -------•-----•--------------------------------------------•-------------------------------- -- ---------------------------------------•-------------- ---------------------•---------------------------------------------------------------------------------------------------------- -Y' 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 Joa uin Local Health District. F (Signed)� � - 1!!fU€ ------------------------------------ --------)�r Contractor) B ---- 0 --- -- ----------(Title)---------------------------------------- - ---------- -------- (Plot plan, showing size of lot, location of system in relation t wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t z DATE----.57.`Z --"0 - - REVIEWEDBY------------------------------------------------ ------ DATE------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------- -------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------- -------------------------------------------------------- -------------------•----------------------------------------•--•---------- 1 FINAL INSPECT N BY Date------------ :. Z - F---------------------------- 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 B-59 3M 3-'63 f.P.OG.