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i FOR OF7a4o, E: � ..- �3 ��' n -------------- APPLICATION FOR SANITATION PERMIT Permit No. ........... .. _-_--- (Complete in Duplicate) Date Issued •_____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �j ---------------•------------ JOB ADDRESS AND LO A 0 9 ----------------------------------------------------------- Owner's Name- -----�L t ------------------ Phone------------------------------------ laz Address - ------•----"--------------------••--•-•.........•--•- - --------------- -- ----•--•-- ---•- --------------------------------------- Phone Contractor's Name__________ ___-- `;��--"-- -- -- ---------- •--------------------------- Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M ❑ Lot size _� . ---------•--------------- - Number of living units: ___/_ Number of bedrooms �"- Number of baths � - ��t. Water Supply: Public system ❑ Community system ❑ Private gy'-'D*epth to Water Table _ p Character of soil to a depth of 3 feet: Sand C] Gravel [ISandy Loam ❑ Clay Loam ❑ Clay C] Adobe Er'_'H4`ardpan ❑ Previous Application Made: (If yes,date--------------------) No &'� New Construction- Yes Eq'INo ❑ FHA/VA: Yes pq No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , ��q/ Material__,i� . .... Septic Tank: Distance from nearest wel _ .Cl"---Dista,n��cyye from foundation__ Capacity,� Q ------SizedU' KLiquid depth_- -- - No. of compartments__ ___-__--- - ` r' Disposal Field: Distance from nearest well_- M----- -_Distance from foundation___ -__---Distance to nearest got line_ .___-_-_. Length of each line -�-��- Width of trenchi _.__....�.____----..-"-_--- 6 of lines..--�----7----- ------- Number --' 9 pp J Type of filter materiall4 -Depth of filter material--- 4"-____-�----Total length____. Q•------- Seepage Pit: Distance to nearest well____��©_______Distance fypm foundation___N/...-__._..Diss�ace toDneea+hst of line.-to---_______ I Number of pits-----oZ------------Lining material_. _ f!- "---Size: Diameter__+ �7_-_"-_---- - p ---- Cesspool: Distance from nearest well-----_-----------Distance from foundation--------------------Lining material__-__-_______-._________..______----. p ----Li Liquid Capacity ...gals. ❑ Size: Diameter--------------------------------------Depth----------------------- q p ty------•---•------------- X Distance from nearest well___---_"____________________________________"-_._Distance from nearest building_____________-__.__--__--___..__-______-_- Privy: � ❑ ----------- -•-------_ ---- ------ i. Distance to nearest lot line------------------------------------- - Remodeling and/or repairing (describe):---"---------�----- - - --------------------- --- ..... ----•-"•---•----- ----------------- --------------------------------------; ------------------------------------------------------------.................................... ----------- -1------ ------------- --- --------- -----------------•---------"-------------------------------------•-----------•--------------------•----"-------------------------------------------•-------------••-----•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County d regula ions of the San Joaquin Local Health District. ordinances, State laws, and rules an _- _ -- -- - ------------ pwiger•aN+4f or Contractor) (Signed)_ - --- -- ---------- - -- --- --- ---------- ---- -------- - By:----------------------•--- - - - -------------------------- (rifle) ---------.. ---------------- (Plot plan. showing size of lot, locetion of syste relation +o wells, buildings, etc., can be p aced on reverse si e). FOR EPARTMEN USE ONLY ----------------- s, APPLICATION ACCEPTED- " ' ----------------------- DATE�z- -- --- ----- REVIEWED BY--------------------------------------------- --------- D BUILDING PERMIT ISSUED------------------------ -- --- ------------ -- ---------- "" --------- Alterations and/or recommendations:___ -------------- FINAL INSPECTION BY------- ""- - - ------ "----------- ----" - - ----- Date----OW_ - `" `- 1 • SAN AQUIN CAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3•'63 F.P.CD. }