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FOR OFFICE USE: -------------------- Permit No. . ?Q ------------------------------------ ------------- - -- APPLICATION FOR SANITATION PERMIT --------------- --------------------------_ _-------------_---__--_-. (Complete in Duplicate) 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 AOCATI �'t - - = Owner's Nam _t.... ---------------------- ---- C �" Phone I-� Address. " -------•��`--1�- II� _�. ",t � t Contractor's Name--------------•--� --• Phone Other Installation will serve: Residence 'artment House C] Commercial ❑ Trailer Court ❑ Motel ❑ the ❑ Number of living units: ---/.-- Number of bedrooms ---S Number of baths ___t___ Lot size -__- 7� -�Z--'----------------•-------------- Water Supply: Public system F1 Community system ❑ Private 0 Depth to Water Table __�_... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----.---------------) No (X, New Construction: Yes No 0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public., is available within 200 feet.) / Dista ce from fou�ation__--__/ ._.---_ M tergal--_.-_ Septic Tank: Distance from nearest well__1-,t Capacity No. of compartments--- �. SizeY �� ---Liquid depth •'�.'_-`}"----------- P Y =`F �Kl Distance from foundation..___y Di Lance to nearest lot li eI ------------- Disposal �- Disposal Field: Distance from neat st well ._ 1--- Number of lines..:_.__..,�_-___________Length of each line7�_�_7f1_..�4_�_� th of trench..___.. `_---------------- Type of filter material j._ -- - `Depth of filter material--/ ___``___.__--Total length____.-�„- ------------------ I I 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--------- ----------- Z-1 Remodeling and/or repairing (describe):_-- //Clll---- --------- - C 7--------- --------------- -------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------- - ---------- ----------------------------------•-------- -----------------------------------•-----------------------------------------------•------------------------------------------------- I hereby cert' tha=osysfe, re red this applicati and that the work will be done in accordance with San Joaquin County ordinances, Staff I ws, reg tions of t San Joaquin Local Health District. (Signed)-w---- ---- --------------------------- ------------------------------------------------------------------------ .___________.-.-(Owner and/or Contractor) By:-- ------------------------------------------------ Title ------------- ---- - -- --- - - -- - (Plot plan, showing size , tion of syste in relation to wells, buildings, etc., can be placed onreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ATE..____ / - - REVIEWEDBY------------------------------------------------- ------------------------------------ DATE--- ----------••------------------------------- ---- N BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------�------'- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------- ------------------•-------------------� -------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------- ----------------------------------------------------------------------- --------------------------------------------------------------- - ------- ---- FINALINSPECTION BY---------- -- ---------------------------------=--------------- Date--------- - � /� ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California .� �* Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.DD.