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F R OFFICE USE: ------------------------------------------------------- Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to fl,e 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. I I�1I /7rr Part W'a JOB ADDRESS AND LOCATION--- ------- Owner's --Owner's Name -------� u _1 - =-----`----------------------------------------------- -7f-` I Address-----l-C-�•-•---c�-�-�--Il✓�H_�:�-----�-----�L7�C-?�- ------------------------------ --•---•---------------------------------------------------------------- Contractor's Name - '01� _----•-------------------- Phone..---------------------- Installation will serve: Resident ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___:__ Number of bedrooms - ---- Number-of baths"-_/___ Lot size ---- _ _ 0_-131- ?.----•------------------------ Water Supply: Public system ❑i I Community system ❑ Private 0 Depthto Water Table 3S-_ ft. Character of soil to aldepth of 3� feet: Sand ❑ Gravel ❑ , Sandy Loam W Clay Loam ❑ Clay ❑ Adobe E❑ Hardpan ❑ Previous Application Made: (If yes,date__-r--.-*°- :_.._._-)-No ❑ New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tan, or cesspo��I permitted if public sewer is'available within 200 feet.) / Septic Tank: Distance from nearest well-,61Q-------Distance from foundation---A -----------Material--'kdc?tY-•---_...---------- No. of compartments_--- 9-77._�`-Size------- Liquid depth__- C-apacity- WjOe Disposal Field: Distance fro nearest well : ?__.._Distance from foundation---/.U_ -.----.Distance to nearest lot line__+ ------ -__- - Number of lines----__--_�-----I-----____-.--._Length of each line-----V-0_r---------------Width of trench___ y--F� �. Type of filte11material- ` � -----Depth of filter material---.._l_ '-��---._-.-Total length___ ----_--_--__--------i" Seepage Pit: Distance to nearest'well_-_' " _ _ ___ -----Distance from foundation--------------------Distance to nearest lot line_---_--_.--__- ❑ Number of pits---1-----------------Lining material------.---.---.--------Size: Diameter------------------------Depth--------------------------------- � Cesspool: Distance fro nea rest weft-----------t-----Distance from foundation--------------------Lining material--------------------------------------- b ❑ Size: Diameter-----`--- ------------------------I-----Depth----------------------------------------------------Liquid Capacity----------------------------gals, ') Privy: Distance from nearest well----------- ------------------------------------Distance from nearest building.--I---------------------------------- ... s' ❑ Distance to nearest lot line----------- --------------- - ---r------------ -------------------------------------------------------- ----------------•------------------ Remodelingand/or repairing je�lscribe):----------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------•--------•------------------------------------------------------ r '-''-_. i.- ----------------•---------------------------- -----------"--._-.-_-•--------------------------------------------------I- �. i f -------------------------------------------------• ----------------•-••-------------------------------------------------------------------------------------------------------------------------------- ------------ - F I hereby certify that I havel�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. t ! (Signed ------- __,_... .. {Owner and/or Contractor) By--••----•-----------=----------------0--------------------------------------------------------------------------------------------(Title)------- ------------------�------------- ----------------------- ; (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -'"`—FOR'DEPAR-TMENT-USE ONLY" `--�-`--�---�- ', APPLICATION ACCEPTED BY --------------------------------------------- --------------- DATE--- -------.----- REVIEWEDBY----------------------------- ---------- - ----- - ------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- -------------------------------------------------------------------------------- --------- DATE---------------------------------------------- ------------- r Alterations and/or recommendations----------- ------- ------ ---------- -----------------•------------------------------------------------------------------------------------------------------ i ------------------------------------------ --------- ------------------------------------•---•--••---------•----------------------------------------- I ---------- AI------•------------- ------------------------------•-----------------••------ ---------------------------------- -------------•--------------------------------------- --------•------------------------------------------------------------------------------------------------------------- ----•------------------------------------------ --------------- ----- ------- - ---------------------------- FINAL INSPECTION BY:.- --------------- - Date.---------400_16- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California ES 9 RrV15ED 8-59 3M 3-'63 F.P.06!