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FOR OFFICE USE: ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .__.!_.... ........`. A ------ -- ------------------------ in Duplicate) (� -- (CompleteP ) 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 AND LOCATION----7•-1-Ak------- 5-0-.-------� r------------- --------- ----0-4a- ---�A--------�/ Owner's Name-------- ........ Phone_'7C�� - Phone__. Address------....�Ca jr +-- ---------- -----------------/;---------------------------------------------------------------------------------------------------------.................................... Contractor's Name----- ---•-- --------•--------------------------------------------•--- Phone................................... Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -A----- Number of bedrooms ,__L_--_ Number of baths __1_.-- Lot size _--_(Ds-i__-_.X___(__� +------------------- Water Supply: Public system T. Community system ❑ Private ❑ Depth to Water Table _7-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe og Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes Dk No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well---►rnx>V%S,_Distance from foundation---_lf>--_-.__._Materia_- L--------Q-------------------- (& No. of compartments--------Z------------Size__: .__x 1___X_ _,_..Liquid depth_-- - ' 1---------Capacity... C� Disposal Field: Distance from nearest well-1k6_1A,-_Distance from foundation......I.Q_.......Distance to nearest lot li(te____ Number of lines-------- ----- _ 9 Len th of each line----_-___ Q �i Width of trench Z ®. j Type of filter mate ria l. +..tt�c•.k--_Depth of filter material-_--.--1__0_-------Total length______--�_Q-----__-_-____--__--_.- // II Seepage Pit: Distance to nearest well----- ,__Distance from foundation-__-_1_Q...__...Distance to nearest lot line-_--5-•----- ..� I Number of pits--------(----------- Lining mate ria lSf-r_YD__C_K-Size: Diameter_-4_...x-(�------Depth----1-C�----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.----------------------------------- i ❑ Size: Diameter-------------------------------------Depth--- -----------------------------------Liquid Capacity----------------------------gals. U1 Privy: Distance from nearest well -------------------------------------Distance from nearest building----_-------_--___-._-.--_-__--_---------. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/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 +be San Joaquin Local Health District. (Signed)---- Psize - --- ------------------------------------------------------------ ------------------------------------------(Owner and/or Contractor) -- --- -- ----------- ---------- ------ ---�- Title - f------------------------- - (Title) (Plot plan, showinf lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------ «- -5----------------------------------------------------------------- DATE---- ----- -4`__j----------------------------- REVIEWED ` j--------------------------- REVIEWEDBY----------------------------------------- ------_----------------------------- --------------- -------------------------_- DATE------ ---------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------•------------------ ---------------------------------• DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- --------------------------------------------- ------------------ --------------------------------------------.-.-------------------------------------------------------------------------- ------------ -----•---------------------------------------------------------------- --------- ---------------------------------------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY:--- t__s----------------------------------- Date S f t ---------------------------------------------- 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 B-59 3M 3-'63 F.P.CD.