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FOR OFFICE USE: ---------- - - ------- - APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ --------- .. 7.G_..... --------------------------------------------------------- (Complete in Duplicate) -___-. This Permit Expires 1 Year From Date Issued Date Issued L/G_s� 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 LOCAt JION... *.. Owners Name...... — ----V / ---------------------------------- Phone-------- Address----- -- ............. -------------------- - ....................�... �" 7 Z Contractor's Name ..................................................... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._;t - Number of bedrooms __" Number f baths ___ Lot size ... tit, --------------•_-.-__.______.- Water Supply: Public system C] Community system 1771Private Depth t Water Table -------- ft. O Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ 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.....................i------:---Liquid depth--------_-•-------------Capacity---•------------_---- Dispo Field _��._B : Distance from nearest well_ __i"-_Distance from foundation..../.Q_... -' .-__..Distance to nearest lot line.. ---�..._.. n Number of lines......... ------------------------Length of each line...- -.%lam__`____._-_.Width of trench----:;�t. ..............------- Type -_.__Type of filter material-,,0_&.-----.---Depth of filter material___--./_8`_"---------Total length_../ .........................;.,! Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El 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: :k Distance from nearest well-----------------------------_--------________Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------_------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--- ------- --•----------------------------------------------------------------------------------------------•--'............................... •---------'----•----•-----•----------•-----------------------•------•--' ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------------------------------------------------- -- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certifythatI 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. (Signed) ._-. ------------------------------------------------------------•------------------{6 d/or Contractor) BY�------ - - -------- ----•-------- --- ----- ---�ion ---------------------------------- ----(Title)------ ----- -- - ------ ---- --------- (Plot plan, showing size of lot, location of system in rewells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYOlt pp APPLICATION ACCEPTED.BY.... - ---- . ----- - ----------------------------------------------------- DATE....a._-.3'GV__.. ----- ----- --------- REVIEWEDBY-------------........... ............................... DATE------•----------'-----.............--------------}------ BUILDINGPERMIT ISSUED...............i.......--------------------- . ------------------------------------ DATE---------------------------------------------------- Alterationsand/or recommendations------------- --------------------------------•-------•-'-•-'---•-•....•-------•'------•-"---•-'•-'•--•----•-•---•--•-•--"..........--•-----•'----•'- _--•-----------------------_-•--------------------------------------------------------------------------------------------------------------------------------•----------------•-----------------------------------•--•-- --"•---- --------------------------------------------------------------------------------------------------------------------•----'------------------•---'-••---•-------------------------------------------------------- ------------- ---_-----------------------------------------------------------------------..-------------------------------------------------- .--. FINAL INSPECTION BY:_"i-- -------- ----- -- Date-------'.3 6 --------------------------------------------- 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 i.P.CD.