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FO OFFI US Jam'" - APPLICATION FOR SANITATION PERMIT Permit No. .1.3j.37 -------------------- ;M (Complete in Duplicate)---------------- -- ---------------- -- -_--_______-__ This Permit Expires 1 Year From Date Issued Date Issued ...V111,6 Application is hereby made to the San Joaquin Local Health District for apermit to cons ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Q 71 S � JOB ADDRESS AND LOCATION---------- - -- ---- - •-•---------- --- •------- ••- Name------------I' ==� --------------------------------- - ' �' --------------------------------- Address ----------- - Phone- Owner's r< Address-----------------------------�----------�------------------------C �-'----�--------------�-�--�---------------------------------...-----------.....---•---------------••----•--------- Contractor's Name--- ----- Phone................................... Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . _. Number of bedrooms . _ Number of baths -,1... Lot size .....a.r'.12-----X.../.<Y_p................. Water Supply: Public system ❑ Community system ❑ Private 2 Depth to Water Table,,Y.:eft. 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 ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ NoZ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic, tank or cesspool permitted if public sew$r is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation------/ ......Material...... --------------------------- No. of compartments________.. :-:---------- `�.X•�CX-- ------Liquid depth_______ ----_---------Capacity..... Gl_ Disposal Field: Distance from nearest well --_• :o.._Distance from foundation...�3cz.. . nce to nearest lot line..._..2 . Number of lines---------------- Length of each line-----,�'_..._ ------- idth of french......_._.. __-__.-..___•-__ Type of filter material C - ._____Depth of filter material...,/2_____________"Total length------- 'T?"�"___ 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..................................... ❑ 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) �t-=__: ----------•-------------------•--•-------•------- - '--•-------•------------------•-----------•--------- -------------------------------------------------------- __-_________._._..____.......___.___.._.._...__._"______ " /f].l _.. `-f.Y- )_______________________"...---__-----_-____.__---__--_------____---. J ✓// 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. O Si ned ---------------------------(Owner and/or Contractor) r By:----------------------------------------------------------------------/ ----- ---------------------- - (T'itle) ------------------------------------- ---- --------- 'h (Plot plan, showing size of lot, location of system in relation to wells, buildi6gs,-etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------- -- ---- "------------------------------------------------------- DATE----------- ------------- REVIEWEDBY-------------------------------------- ------ -------••----- DATE-------------------------------------•-------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------•---------- Alterationsand/or recommendations:............................................................................................................................................................... ------------------------------------------------------•-------------------------------------------------------- ----------------------------------------•---------•-----•-----------------•-------.....---------•---------•-- -----------------------------------------------•------------------------------------- ---------------- ............................. -------------------------------------•---.........---------....---------------------- ----------------------------------------------•-------------------------- ------------------------------------------------------------------------- ---•--•----------•------------------------•-------------------------•---. -----------------------------------------------------------------------------------•-------------------------................................................. FINAL INSPECTION BY:. = Date ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weft Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 2•69 F.P.CD.7M 6.60 '