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FO -OFFICE USE: 7/ . r - 8 APPLICATION FOR SANITATION PERMIT Permit No. .. . ....... ... ' l -` - _- S 'ys=� (Complete in Duplicate) l9 6S� 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 descrbad. This application is made in compliance with County Ordinance No. 549. { JOB ADDRESS AND LO ATION A. X/ �4-- --- ----- -- ------------------------------------------------------------�-------------------- ---------- k Owner's Name = =_ ---------------------- ----- PhoneF p AddressI -------------------4 --- ------------ ------ -----------....---•-------------------------------------------------------------.------ Contractor's Name---------------------- Gi __ �------------------------------ --- ------ Phone----------------•------------------ ------ -- ----------- Installation will serve: Residence Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-__ _- Nurrjber,of.,bedrooms _`V.N tuber of baths.. Lot,size ---- -. ---� ��__--------.- Water Supply: PublicoY stem [Community system ❑ Private F] Depth to Water Table _Xrff. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sa dy Loam ❑ Clay Loam [❑ Clay E] Adobe Hardpan ❑ t Previous Application Made: (If yes,date---------------------) No New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p�ujb�ic sewer is available within 200 feet.) r Septic ank: Distance from nearest well_-lyP�--Distance from fou d tion__'16--.-._Materi�l ------ -- -------- - k No. of compartments----------- -- Size-__-151X6)(-��__Liquid depth...._-_4/c4-_--------Capacity.-._ ---- p °-�'" '.a `rl ..-"� Length from foundation_-_.l -----.Distance to nearest lot line_-- -- _.--. pis os Field: Distance from nearest"well....-g -_ Distanh of-each line__---_--..--- --6- Width of trench.-__---��-- Number of lines'__-' -- r---------•-- Type of filter materia_ _ P- /- I� __(c c Depth of filter material-------�_F4/'---..Total length--------------------Srd---_----------- Seepage Pit: Distance to nearest well........_'-------------Distanc_e,from foundation-- 4-----------Distance to nearest lot line----------------- ❑ Number of pits----------------"Lining material--` .-------------Size: Diameter-----------------------Dept h--------------------------------- \ Cesspool: Distance from nearest well-- .-_----------Distanceffrom foundation............. ....Lining material--.---_-----_--.-.__--_-.-----.---- ❑ Size: Diameter--------------- , =--`-_��----Depth----- -------------- ----- `" t-Liquid Capacity- --------------------------gals, rt � _ t _ [ 4 y 11` - i Privy: Distance from nearest weir._--..-= "_ _ �---� ----------------Dunce" from nearest building------------_------_--__---..---------El - s -: d --- Distance to nearesloline '' -- ---------- - ----- 9 I p g �� -- --•-- - ----------- --- �C�C9�l ----------- Remodeling and/or re aEr�n describe:-- . :�•------------------------------------ f -----}=-------------- ----------•---------------------- - ------------ ---- --- ------- --- -- ---------------------------------------------------------------------------- ----------------------- � 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. _(Owner and/or Contractor( (Signed)----- -------------- ------ --- ---- = Tifle (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY w APPLICATION ACCEPTED BY a ,cc -------------------- DATE.---- 1--- --- -GS'........... ----------- REVIEWEDBY--------------------------------------------' ----- ------------------------- -"--------------------- DATE BUILDINGPERMIT ISSUED-------- --------'------ =--------------------------------------------------------------------- DATE----------------------------------- -------------------------- Alterations and or recommendations:...... :..... `"--------------------------- --------------- ' a ��`` r tom+ - � '�- - -- - � r-�--- ----------- - ---------- ----------------------_-- ..... ----------------------------------------------------------------------------------------------- ---- ------------- -- y ------------t----------------------- ----------------- •-------------------- ------- ------------ -------- - ----------------------- - ------- ------ - ---- FINAL INSPECTION BY:- --- .---- '�----- Date--....._ d_"5� fads ------- 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 F.P.O O.