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FR OFFICE USE: �, t Q -------------------- l° ------------------------------- ------------------------ APPLICATION FOR SANITATION PERMITPermit No. .- /7 --------9' q ,jl_--_--"__________________ (Complete in Duplicate) ---------------1 l/,Lf Date Issued ._--.-. 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. JOB ADDRESS AW LOCATION --- - ._ ------------ ----------------------_--- /� A Phone------------------------------------ Owner's Name....`-�`� � �'� -------------------------u--------------------------------------------------- i1� - -1,41" _ Address----- - --•-------- Contractor's Name-- Phone --------------------------- ------- --------------- - Installation will serve: Residence ❑ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....1_-. Number of bedrooms __l_._. Number of baths ---I--- Lot size ----Z-S7:KZ`- .........------------------_- Water Supply: Public system 9g_rommunity system ❑ Private ❑ Depth to Water Table k�z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No V New Construction: Yes ❑ No 0," FHA/VA: Yes ❑ No 59- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic IDistance from nearest well-----------------Distance from foundation--------------------MaterialI------------------------------------------------- ❑ No. of compartments-------------- -----------Size------ -------•-------- -----Liquid depth-----------------Y--------Capacity------------------� Disposal Fiel Distance from nearest well-- --"_._Distance from foundation../�-----------Distance to nearest lot line------------ - �.�, ... ( ;jF/ Number of lines-----/_.�_�__-.---��--_-_-_-_---_-___Length of each line--- __G'__-'___"--_____.Width of trench- ' -*---_--y_-r-______ Type of filter material _ 0-C�_ _____.Depth of filter material---l8---_--.._."Total length------ 5"t2_...___��_____.____ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----_.---_-__--- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.--------Depth-..-__.__..__----.----------- --- Cesspool: Distance from nearest well__.-___--_-_----Distance from foundation------------------".Lining material-_-.__-_--._-.--"_---_"---.____-____-. fp ❑ Size: Diameter----------------------------•---------Depth.---------------------------------------------------Liquid Capacity---------------------------- V Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__""-_--_-___---___._..•____".__.-._--.-. P' ❑ Distance to nearest lot line------------------------•----------------------------------------------------------- - Remodeling and/or repairing (describe):--------------•---------------------------•--------------------------------------------------------•-----•----------------------•--•------•----------•--- Ie -------•------------------------------•--•------------------------------------------------------------•--------------------•------------------------------- -- ------- ------------------------•------------•--•--------------------•----•--------------------------•------•--------------•------------------•--------•-•------------------------ 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. -- C�� ' c�_ t'�` �----------------------- (Owner and/or Contractor) ' (Signed)--------- ----- ---------- 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----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------ -------_:.----------------------------------•----- • - DATE------------------------------------------------------------- Alterations and/gr recommendations------------- _{-_L t ----. . r z_ c- . . T�._--- ---------------------------------- -------------------- f ... .�lr_.C... •----- •-----------•-------------•--------•----•---------------------- ------------------------•------------------------ •------------------------------- ----------------------------------- --------------•---••----- FINALINSPECTION BY:.----x—/-------- ---_:------ Date. --------------------------------- 'A 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 8-59 3M 3-'63 i.P.DO.