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FOR OFFICE USE: ---------------------- v� APPLICATION FOR SANITATION PERMIT Permit No. ..... _�_ :/Y �\ ---------------------- ------------------- -------------- -------------------- - / _______________________ _ __ (Complete in Duplicate) /3 -- --------- "---- -- 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 herew de r ed. This application is made in compliance with ount Ordinance No 549 _yL JOB ADDRESS AND LOCATION.._.,.. _________ _ .___ _. s r. f d _ Phone------------------------------------ Owner's Name ------- ------------- ---- �= '�� - -� 8� -- ..,�.� _ �G' �,. ._.. _ Address --- .f ._ Contractor's Name------------------------------------------------------------------------------------------------------ ------ �- --•--- Phone ••... ----•---�-- Installation will serve: Residence ❑ Apartment House E] Commercial E] Trailer Court Motel Other �4 Number of living units: -------- ber of bedrooms -------- Number of baths -------- Lot size ____/>4.0-------------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to ater Table �d.. ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes R-< ❑ FHA/VA: Yes ❑ No ❑ 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 foundOon-__-—pv!"—Material____ __ _ C/ 6 --•--- - ( No. of compartments-_-__Z-.-_-_-._.-_Size_-- ."3{ ...Liquid depth__-___$1-__-_._.._.-_-Capacity___ . Disposal Field: Distance from nearest well._----_-_._Distance from foundation,A0_: __- 9istance to nearest lot line____-._ ?rem n .L-, ® Number of lines----------_:--___- __- _.,_Length of each line______-<--_-`J--------------Width of trenc--------- _, _ _.._.._____.__ Type of filter material.-_I Depth of filter material----./__ ----------Total length......... _.,___b-___________________ 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----------------------------------- ---------------------------------------------------------------- -------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------..--------------------------------- ---------------------------------------------------"----------------------"--------------------------------------------------...----------------•------------------"----------------•--------------------------------------- ------------------ -------------------- ---------•--------------------------------------------- •----------•-------------------------------------------------------•- -.----- ---- 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. =--- -- ----------._L -� i- - ._.. _ :- --- ------------------ ----- ---------- - ------(Owner and/or Contractor) B a ----(Title)----------------------- ---- Y••--- -- - - - - - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F TM,ENT USE O Y Ile APPLICATION ACCEPTED BY---- +, .�- -t~:_*l,+e .: DATE '`� -- ` REVIEWEDBY----------------------------------------------------- ------------------ ------------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------_ ._ _-__ _.____- DATE------------------------------- Alterations and/or recommendations >3 V, - F a /V7 °t4X41 4 � _ -- fi ��! {Q� j; -� �;1�1(d' 'L' ` a------ -------------------------------------------------- ---- ---- --_--_ .. _ _--_-. _..._.__. __ "`a-_.. _. :�--------------_----------------------------------------------- ------------- _"-__--_.-__. .. ._._. . ._"._------____--_ ' _ I ----- --------- ---- -- - - -• -- ----------------- INSPECTION - �G - - . Fo ci Date------- ... 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 WsaT Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 13.59 F.P.DD.2M 6-60