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F OFFI S ----------- ___________ _ _ ------ APPLICATION FOR SANITATION PERMIT Permit No. ..1.__ ._.L..�? - ----- ------ (Complete in Duplicate) -------- This Permit Expires 1 Year From Date Issued Date Issued ___�:?"A3. 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 LOCATION---J' /Z ' Owner's Name...._.. ----- `�._ - S ..D C/.,-�- `` Phone Address.--•---•• r _ - ------------------------------------------------------------------------- -----------------------------------------•-•- Contractor's Name- ----------------------------------------------------------------------------------------------------••--•---------- Phone................................... Installation will serve: Residence Ejl*�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: .____ Number of bedrooms _ ___ Number of baths _/__-_ Lot size .g:lr k Water Supply: Public system Community system E] Private ❑ Depth to Water 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, 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 204,feet.) SepticTank: Distance from nearest well---��_Distance from foundation _..._._ ..Ma to ri aI �V--¢41.,;:1:=7r,!-....... No. of compartments-'____-------------- Size....? _.___Liquid depth -----_-r4____ _________Capacity.R_K72�. Disposal Field: Distance from nearest well--/- I---0. :Distance from foundation ...1-421_____-Distance to nearest lob line------- Number _•..� Number of lines______;=--__--- Length of each line_' '_;_�_6_ - .......Width of trench _ __.P....•.._. Type of filter material-__ , .. aaf pth of filter matetial___-__/_�____-_-Total length..._:_. ,f ----_---- Seepage Pit: Distance to nearest well---- T--____Distance from foundation__!/...0--••-_•.Dista cep o ngarest lot line_... _i___- Number of pits.-..--- ___ __Linin material- fie-`Q _ Size: Diameter__-__..___. ------ p ,..�s_ 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------------------------------------------ F1 ___-_,__ -•-______ -•-____--__-___._.❑ 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 laws, and rules and regulations of the San Joaquin Local Health District. (Signe9)--------- .L. � --------------------------------------------------------------------------------------- --------(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-----A `j �` 'z'_------------------------------------------- DATE------611.R1_.4__;)-------_------- ------ REVIEWEDBY--------------------------------------------------------------- •--------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------.------------------------------------ DATE-----------------<-_----------------------------------------- Alterations and/or recommendations•. ' _ /..... ---------------------- --------------- 4=_.---------•-- =� ---------•--- ce _c 9-,.----- 1t c.r,_� ��t` -4'' .-s c ` -- - --------------- --- .mac--�---1'=� � -----•-•- •---------•- .............. FINAL INSPECTION BY:.-A .... < �-------------------- 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.CD. •