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rUK UI-Nl _t: Ubt: - q ------------- --- --- _ f 2-l- -- �Q�.`3�_ ------------------------------------tl-%---------------- APPLICATION FOR SANITATION PERMIT Permit No. -.164kz ------------------- (Complete in Duplicate) - Expires 1 Year From Dat Date Issued ___ This Permit Ex p e Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei es I This application is made in compliance with County Qrdinance No. 549. JOB ADDRESS AND LC ION____ - ------------ ----------- --- ---- Owner's Name-----____ ------ H -------------- Phone Address ------- -------- -• . ------ -- ------------------- Contractor's Name_ _ ---------------------------------------------------------------- _ E] ----.__._.•---- Phone Installation will serve: Residence Apartment House ❑ CommercialTrailer urt E3 Motel El Other ElNumber of living units: __ Number of bedrooms __�__ Number of baths o size �� s Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/S___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay F� Y ❑ Y ❑ y ❑ Adobe 'Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ °(1 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/10-Q__---Distance from foundation - --.Mate�ial__�,ILQ_`_ - No. of compartments ---------- ------- -_-__--_-_-Size_ -.,?Ir.�1:__)(____-----_-Li Liquid de th___ _Capacity Disposal Field: Distance from nearest well_AD-O__._Distance from foundation,lDO---------Distance to nearest lot line._S-�____.__ Number of lines_____ ____________________ __ Length of each line__-_NS-S'-•_---__---Width of trench---,._______ Type of filter material.S1_ ____ _ �! �__Depth of filter material------� V_-' __._Total length____.__. S_:S ------------------------ •�� eepage Pit: Distance to nearest well ---------------- from foundation___-_- -----------Distance to nearest lot line_____________-_ ❑ Number of Pits---------------.------Lining materia-----------------------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): ____-----_ % -- ------------------ -- s ,t_Gt------- ---------------------------------------------- 1s . -- -- ------------- hrebI -----pre --- his p --------------------------------------------------------------------------------------------------------- ---------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules �� regulations of the San Joaquin Local Health District. (Signed) l .... + -- --------------------------------- -- -----Owner and/or Contractor By:------------------------------------•-------- ------ ) -------- (Title) (Plot plan, showing size of lot, location of system i n to well uil ' 4------------------- ---- ------ --------- sb dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_ ------- ----.__V--C/_S'_ fid ' 'Q�!'f �% DATE------------- ---------------------------------------- REVIEWED BY � /�-3 ------- --------- DATE --- ILDING PERMIT ISSUED ----------------- - DATE. Alterations and/or recommendafiions:__-____-____--..-._--_. --------------- ------------------------------------------------------------------------------ FINAL INSPECTION BY---------------- -V_5------------ ---------_ Date------------/.D - 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 8-59 34 3r 3'F.P.CD. ...dY