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FOR OFFICE USE: �.� ( L �I .. eo 6�_3 1 - - -- - -- f� T 1 --------------------------------------- ----------------- `y APPLICATION FOR SANITATION PERMIT Permit No. .I�El... .... --------------------------------- -------------------- (Complete in Duplicate) Date Issued •..��.�/�S/ --- ----------------------------------------------------- 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. A;k--A m/aC3 t r .� �J JOB ADDRESS AND L CATION. 'Yj�� a(�b.�- ' Owner's Na , -- • -•--j- ......................•... Y -- .- ------------------------------------------------------------ Phone.................................... --Q'� Address-------- ._ . _ .. .a....�......«._..` ------ _.. ..... 4- ......F................................................................................... Contractor's Name. , J; ----------------------------------------- ................. Phone........................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [--At Number of living units: .`._ Number of bedrooms^__. Number baths -------- Lot size ............................................................ Water Supply: Public system ❑ Community system ❑ Private (V Depth t ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam Clay 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.) t Septic ank: Distance from nearest well_i -------Distance from foundation-------f_0......Material... _: - No. of compartments---- --Z --------- Size-3••x--`�-.---�1 _. 1-iquid depth-- Capacity . � r ! r- f–,Dispos field: Distance from nearest well. __,*0d-.__Distance from foundation..410!._.._..Di ce o nearest lot Tina .... j Number of lines------------I..__ -.------------Length of each line--------S-Q-------------Width of trench__.�!_______________________ Type of filter material___. __�._____...Depth of filter material------l.fs__-------Total length......;,.��?_<_____________________ Seeps it: Distance to nearest well------/A4P-_/_Distance from foundation_....) .).__..Distance to nearest lot line..� ._ Number of pits-.-.-----{-_-.____-Lining material__.�.f'�____.Size: Diameter.___-.,,�-�........Depth___-5�________________ 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----------------------------------------- ❑ Distance to nearest lot line--------------------------------------- Remodeling and/or repairing (describe) -----------•--------------------------------•--- ----••-----........................................................ --••-•-----•--••--•••-••-•---•-•----•--------------•----------------•----•-••-•----------------•--------••----•-•--------•-•---------------------•----•---•------------------•--------------•--•-•-----------------------•- - --•---------------------•-•-------•-----------••-•----•-•-•------•------ -•--•----•--••--•-•-----••-•--•-••------•-•-•---••-••----------------•--•-••-•-----•--•------ -•••••-------•--•------------------------••-•- ---------------•--------- ----- ---------------------------•--------------•----------------•-----------------------------•----•--------••--•------•-------•----------•---•------------•--•---------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------------------------- ------------------------------------------------------------- rand/or Contractor) By:------- •-(rile)-- --- --- (Plot plan, showing size of lot, location of system in relation tol wells, buildings, etc., can be placed on reverse side). Al FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - - ------- = ---------------------------------------------------- DATE.....'''-J_7.wlSs ------------------------------- REVIEWEDBY -•------------------- ................ DATE-----------------------•----------------------- BUILDINGPERMIT ISSUED...................................................................................................... DATE................. Alterations and/or recommendations----------------------------- ------------ -------------•-------------------------------------------•-- ------------------------------------------------------------------------------------------- ------------ ------------------------------ ---------------•---------------------------- ---------------------- ---------------------•--- ----------------------------------------------------------...................................-------------------------------------------------- ----------------- -•--------------------------•---------------------------------------------------------------------- .............. -------------------------------------------------------------------- ------ ------ FINAL INSPECTION BY:.. 5;z- ----------------------- Date----- ----------- ---- - 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.CO.