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FOR OFFICE USE: / --------- ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. c;7Z . .. =---- ------ (Complete in Duplicate) - 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. J B A13DRES S AND LOCATIONo. - - � f ---- _ _ ----------------------------------- Owner's -- ---- ^_ - Owner'sPhone I Name.__ sr___ ` _ -Phone_____________________ _ -------- --- Address---- 50---0---------a-i; _ - Contractor's Name-- - n - � Phone. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.f__ Number of bedrooms _' Number of baths __�___ Lot size __._-� �__—= ------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay q Adobe ❑ Hardpan Previous Application Made: Ilf yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ 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 wel!-----------------Distance from foundation--------------------Material __._______________._.________.____...--- El _ No. of compartments--------------------- Size-----------------------_--------Liquid de th--------------------------Caacit •Dispos ield: Distance from nearest well------ Q._`---Distance from foundation__S �'_.......Distance to nearest lot line__9_(____I Number of lines----------f------------------------Length of each line----- --7______------------Width of trench.--2.-I------------------� Type of filter material---------- �' *----_Depth of filter material-----ate`.-__._..Total length------7`�'_f_______________---_� Seepage Pit: Distance to nearest well---------------------- 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__.___.____--________._____.:_.____' 1 ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gal { 1 Privy: Distance from nearest wel3-------------------------------------------------Distance from nearest building-------ti___-______________.__..__._.. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------- --------------------------------------- Remodeling and/or repairing (describe)------ -------- --- -•------------------------------------------ter-- .�...- ---- _____________I -. ----------------------------------_-----------------------------------------------------------------------------------------------------------------------------------------------------------_ ---------------------------- I __________________________I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State 1 +�snd rules and regulations of the San Joaquin Local Health District. 1 { Si ned . ------ ------ ---- and/or Contractor By t-- (Title)_ x-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------------------------ DATE----- x_74-7---- ±---- ------------------ REVIEWED BY-------------------------------- ------------ ----------------------- ---- ------- ---------------------------- DATE------ ------------- --------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------- --- _------------------------------------- DATE------------------------------------- ------ ---------------- Alterations and/or recommendations:------- -- --------------- ---------- ------------------------------------------------------------•---------------------- -•----------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:. , --- Date-------------------- ----------------------------------------------------------- SAN ------------------- -------------------------SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Na:elton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Cafifornio Tracy,California F.RC0. o