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qF OFFICE USE: - -3 .. �� I APPLICATION FOR SANITATION PERMIT Permit No. ___ I . 1...:. --------- = -------------------- ------ -0 - (Complete in Duplicate) -�! --------------- --- This Permit Expires 1 Year From Date Issued 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 AND LOCATION..........11S"7------------Jy�1e7....-- ------------------•----- ST!' ............------------------------- Owner's Namer�/L ----------------------------------------------•----------------•--- Phone., G'�S—'7D8.tr Address------------------------•----------•• ,-- ---------------------------------------------- Contractor's Name-----....��f/1�._ Phone.. Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _ Number of baths ---4 Lot size -__, Q_,X.__ILJD--_-_-•_______-_•_____________ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 0.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe R Hardpan ❑ PT Previous Application Made: (If yes,date-----------_--------) Nov New Construction: Yes ❑ NowFHA/VA: Yes E] Na TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation--------------------Material-_-__-__----_--___-___-_----_______-----__-_-.--. ❑Cj � No. of compartments--------------------------Size............................---Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well_A40W497 Distance from foundation._&—_1__-____.Distance to nearest lot line......,-2_-- (�j Number of lines----------/----------------------Length of each line--------c.Xs__--------------Width of trench----------- ....'........... Type of filter material__'Z0_C_/ -----Depth of filter material___--, -._.Total length.............. --------------- Seepage . .!__--.___--__-_Seepage Pit: Distance to nearest well-/Vf"�._' ___Distance from foundation.....AC.'_..Distance to nearest lot line-_---,A___--__--_ W �� 2 � Number of pits---.-/--------------Lining materlal__�p(_'/�,_.Size: Diameter---------- Depth_._.___._..____.S.____i_______.. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter-------------------------------------Depth---------•---------------------------------------------------------------Liquid Capacity-..-------------------------gals. Priv Distance from nearest well-_____ ------------------------------------------Distance from nearest building ----------------------------- y ❑ Distance to nearest lot line------------•----------••------------------------•---------------------------------•-- ---------- Remodeling and/or repairing (describe):---------'zi; ------ = ----------------------------------------•••----•--•-------------•.............................................................. --------------------------------------•--•-------•------------------------------------------ ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- ------ 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. (Signed)------------------------_-- ---------- ----------------------------- ----------------------------------------------(Owner and/or Contractor) BY: (Title) --------` ------ ----- --- - -. y_ (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----A{----------- `v=----------------------------------------------- DATE------ REVIEWEDBY--------------------------------------------------- ---------------------------------------------------- DATE............................................................ BUILDING PERMIT ISSUED------------------------------------------ --------------- DATE-- -- ----- ---- --L-- Alterations and/or recommendations:-.. 9 ___._2G _ 11 7� - __ _ - ------ = _ r`-.. �= ----•-------••--------•------------ ------------------- ----------- ------------------•--------------------- ----------------------------•-------------------------------------------------------------------------- ------------------------ FINAL INSPECTION BY:----- L� ' -------------------- Date.... ...... -"1------------ ---------------------------------- SAN --------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-S9 3M 3•'63 F.P.CD.