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FOR OFFICE USE: __0----------------- __._________-.-___--_ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. . .. � ---------------------- ------- -- --------- (Complete in Duplicate) Date Issued22:6�5_ _..........-------_-------------------------------..._--- I 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. ppm JOB ADDRESS A L CAT[ l v- I .r�---------- -------------------------------- Owner's Name--- 11 -___ `�� r - Address------------- •sbP----- 5---..-------------IQW. ------------A/--....or...--V-_----Rtmf, �p r Contractor's Nam ---------- 'S ----•--••-----••-•----------------••-•------------- ------ Phone. -----.------------•-•------_----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I____ Number of bedrooms_-3---. Number of baths __ __ Lot size ____?� _______-______________________ Water Supply: Public system ❑ Community system ❑ Private [�'_Depth to Water Table .16_ 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 Er-__'New Construction: Yes ❑ No [q--FHA/VA: Yes ❑ No ET--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi k Distance from nearest well-----------------Distance from foundation--------------------Material--------------_..__-_-___-___-_-__.-_-_____-. ofcompartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--••------------------- Disposal,Field: Distance from nearest well-O-_Q---_------Distance from foundation._t1-------------Distance to nearest lot line__.__._____ Number of lines-----/----------------____________Length of each line___7S----------.----------Width of trench--__ _`�. i -__�'... Type of filter material_ WOC-A--------Depth of filter material--Jr--- length----7 --_____________-_-____.-_ 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: 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 la and rules a d r ulat' ns of the San Joaquin Local Health District. (Signed) - ---------------------------------------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------------... --------- (Plot plan, showing 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-------- -'- REVIEWEDBY--------------------------------------------- -------------------------------------- - ------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------ -------•--------------------------------- ----- DATE--------- ---------------------- --------------------------- Alterationsand/or recommendations--------------------------------------- ----------------------------------------------------------------------------------------•----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------•-------------------- ---------------------------- ----------------------------------------------------------------------------------------•_--------------------------------------- FINAL INSPE LL ----------- - - -- --- Date-------------3---' 2 ----- -1 66--------------------- 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 F.P.CO.