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FOR OFFICE USE: 1 f � � - - -- — ----------------- AFAICATION FOR SANITATION PERMIT Permit o. .... ... .. ... ------------------ ---------------------------------- y (Complete in Duplicate) - _ . Date Issued ._.. --__,�e ------------- -' _---.- -----.-------- 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.^ 3 t -•------------- ------------------------- -------- JOB ADDRESS AND LOCUTION... y'_ z - Phone /'---- -------------- -- ----- - ---------------------Owner's Name------------ ---- ---------------------------------------- --------------------------------------- -----------_-------�--�- ---�--`- --------- 5� i Address ------------------------ .1Z. " ' � 5 Phone..-.....--••-•-------•-----•------- Contractors Name. 1.[/�!� 'i Installation will; serve: Residence �parfinent House ❑ Commercial ❑ Trailer `Court ❑ Motel ❑ Other ❑ Number of living units: -----l_- Number.of bedrooms I_,L) Number of baths Jl-k Lot size ----- ------------------- t Water Supply: Public system ElCommunity system [IPrivate © Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan F] Previous Application Made: (If yes,date---LLQ'--------------1 No OR--"`New Construction: Yes [!T11No E] FHA/VA: Yes ❑ No i 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 foundation-------------------Material--------------------------------.---------------- ❑ No. of compartments---- `---------------Z--Size--------------------------------Liquid depth--------•--=----..-'__.. Capacity.. f. disposal recd: Distance from nearest well-__,rV------Distance from foundation____- --_-----Distance to nearest lot line --_- t umber of lines___________--�TT rLength of each line__- �- ___I�__-_.Width of french.-____.._-�--_-_.______________ Type of filter material..l__ 7rj�-IP¢'_. epth of filter meferial___._.ff----------Total ,length-------_&d-------------------------- Seepage Pit: Distance to nearest well' _______---._-_---Distance from foundation------ .....:......Distance to nearest lot line__._________._.._ ❑ Number of pits------------- -------Lining material------------------ Diameter------------- --Depth-----'---------------`=----- t�+ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-___._--------.-_..._____-.---_----.. I ❑ Size: Diameter----- ---------------------------------Depth-------- :--------------------------- -------------:Liquid Capacity----------------------------gals. { Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------------------- ------------ ❑ Distance to nearest lot line--------------------------------------------- - ---------------_----- ---•------------------------------------------•--------------- -------------- --- -- _--- -Remoing nd or re airin de tribe : � ! ------------ -------_--_--------c-'-- -------- ------------------------------------------------------------------------------------------------------------•-----------------•-----`-:---------------------------------------------------------- I hereby certify the+ I have prepared this application anItthe work will be done in accordance with San Joaquin,County ordinances, State laws, and ru s and regulations of the San IJon Local Health District. (Owner and/or Contractor) (Signed) ------------- --------------------------- O By:--•--------------=- ---•-•-----------=----------• ---------------------------- -----=--------------------------- = (Title) - (Plot plan, showing size of lot, location of system in relation to wells,buildings,,etc., can be-placed on reverse side). + FOR DEPARTMENT USE ONLY r' APPLICATION ACCEPTED ABY-- -------- --------------- ------------------ -7----------- DATE.---- 1 REVIEWEDBY---------------------- ---- -- ------ ------------------ ------------------- --------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------ ------------------------------ ---------------- � ---------------- DATE------------------------------------------------------------ Alterations and/or recommend a+ions:- ----. -- ------ -------- ---- ------------------------------------:- -- - -- --------- ---------- - - - X / =--------ltd _d7/•r!i:- G�-.�- --- - -- � --- - ----- -w - - - - - - -- --- ---'=-------==--- j 26-�6 77?zr,a clic: c^--`-- ----- ' �'z `a.• 6- . - p a-" ` w Z -F ---- ------------------------------ ---- c-!� . - ` 4 „ '�. FINAL INSPECTION BY: A :: Date-----=? .{. -� -ti SAN JOAQUIN LO0AL_6L.EEALTH DISTRICT 1601 E.Nazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy;California E4 9 REVISED B-59 31-1 3•'63 F'.P.RP.