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-FOR OFFICE USE: i --------_1------------------------------ ------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 7 .. (Complete in Duplicate) 1 -------------- ----------- - 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. __#A07017 JOBADDRESS AND LOCATIONI ----------------------------------------------- --- -------------------------------------------- ------------------------------------ Owner's Name ..... :� ----------- -- -------------------------------------------------------------------- ------.. Phone-------------------------------------- Address 1 !_--� ��.1 � --------_--_-- �A2Contractor's Name ------------------------------------ Phone------------------ ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other l Number of living units: /---- Number of:bedrooms -a- Number of baths _/-_ Lot size ........1 *�� -------- a Water Supply: Public system ❑ Community system ❑ j PrivateDepth to Water Table /8. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ I Previous Application Made: (If yes date__-___-_-----_--) No ❑ New Construction: Yes ❑ No)< FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___;;; 0_-_.Distance from foundation---Ste_.__...Material__IF ------------._____________________. No. of compartments_"___-------.._ yam_ 5 .`f q p. `$_/__1------------Capacity�ie6_�_ ` :Size_____..._r'-______-__s Li uid de th__.._ Disposal Field: Distance from nearest well50--.Distance~from fo ndation__.-Ird_'__Distance to nearest lot line--/ 40-/ ® „ Number of lines_______tz�-_-__.._.________.:Length of each line�,�__-__�_4.__-.Width of trench_____ .4�_.___.. _,_-.__. Type of filter mate ria l.�..-.r__ FA-C --__Depth of filter material-_/_A__�--__Total length__________________��_�__7_---- Seepage Pit: Distance to nearest well---------------_------Distance from.foundation--------------------Distance to nearest lot line----------------- 1771 -._- _-__--_-❑ Number of pits----------------------'Lining material--------.--------------Size: Diameter.--------- -----------Depth---------.---------------------_ Cesspool: Distance-from nearest well_________________Distance from foundation_-__-___ .._:__._.Lining material------------------------------------- Size: - --_.-__.-_ . _-_-__.-----.__-Size: Diameter-.---------------------------------------Depth ------------ ---------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well--------------------- ---------------------------Distance from nearest building------------------------------ ----------- Distance ---- --.Distance to nearest lot line------ -----------'---------- = ---------------------------------------------------------------- ---------- ------------- Remodeling and/or repairing (describe):_ .. - - -----------------------------i-•-----i--=-------------------------- s -----------------------------------------------------------------------------------------------------------------------------------:------------------------------------------------------------------------- I her at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan s, State laws, nd rules and regulations of the San Joaquin Local Health.District. I --.-__ _ _ _ -----.._. . caner and/or Contractor (Signed) s � / ) d ' BY� ® "4 (Title)---- ---------------------- -------(Plot plan, showing size of lot, location of system in relation to wellbuildiings, etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------- --------------------------------- ----- ----- DATE------------------------- ------------------------- REVIEWED BY--------------------------------------------- -----------------------------------r-- ---- p--- - DATE------5�--�-2--�-�--------- ---•-----------•---- ------------------------ BUILDINGPERMIT ISSUED " -------------------------------------- DATE--------- ---------------------------------------------- Alterationsand/or recommendations---------------------- ------------------ ----------------------------------------------------------------------------- ---------------------------------- --------------------- --------------------------I------------------------------------------------------------------------------------ =-----------------------------------------------------------------------------------------------------------------------------------i ----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------.:----------------------------------------...----------------..--------------------------------- �I j - - ------ 6 � .— -- - -------------------------------------- FINAL INSPECTION BY---------- ------- Date------------------- ----_--- - -/-- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 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. fff E I