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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- -- ------------ ------------------A- - (Complete in Duplicate) Date Issued __-___/4 3 This Permit Expires 1 Year From Date Issued -------------------- Applicafion 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 w' h County Ordi ante No. 549. JOB ADDRESS AND L CATION___-- t yam` wr- - l-�-� ------------------------=- --- ° V = re Owner's Name-- " �1�,�--------------------- - "'�` t-----------•------ ------------- ---- - ------------------------------------ Phone------------------------•----------- Address /4 + ---7 ------- ---- Contractar's Name--------------------------- ----- -/ ------------ Phone...- installation will serve: !Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ oof� / - Number of living units: _______.Number of bedrooms ___ -_" Number of baths ___e1� Lot size _____L"_- .`-----•--•-------------------------------- _ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __7__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cay ❑ Adobejx Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No � New Construction: Yes FHA/VA: Yes ❑ No M---' 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-Sr---- ell______Distan e from fqdation----- _____----" erial _ a��No. of compartments-_—, ---------------size___ Liquid de th_ ��acify__/,Z Disposal Field: Distance from nearest Pell__- —�___-_-Distance from foun�aior�� D��stance to nearest lot r S !�- / 5S Q ---•----•-------- Number of lines-------- Length of each line_-___-____._----_�-----______. Idth of trench._. _ ________ I^ Type of filter material Depth of filter material__�Y____________Total length-----3._3�____________________________ _ Seepage Pit: Distance to nearest well ______________-------Distance from foundation--------------------Distance to nearest lot line--------_________. ❑ Number of pits----------------------Lining material-------------------------Size: Diameter-----------------------Dept h-----------.--------------------- Cesspool:. Distance from nearest well_________________Distance from foundation------------- ".Lining material----------------------------------- i ❑ Size: Diameter--------------------------- -------Depth---------------- - -----------------:- --- ---- Liquid_Capacity-`---------=---------------gals.-:2, Distance from nearest well-------------------------------------------------Distance from.nearest building._________.__________-___--____._ ❑ Distance to nearest lot line-- - ------------------------------------- - ---------------------------------------------------------------- ------------------------------ rRemodeling and/or repairing (describe)---------------------- --------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ------------------------ -----------------•---------------------------------------------------------------------------------------------------------------------0? ---------------------------------------------------------------------------------------------------•---------------------••----------------------__-__------------------------------•-------•------------------------=------- ----------- - -- -- --------------------------------------- --------------------------------------------------------- ----------------------------•------------------------------------------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed) -- - ----------------------------------- ----------------------------------- -(Owner and/or'Contractor) By:---•---------------------------------------•-.----------------------------------------------------------------------------------- [Title) --------------------------------- - ---- (Plot plan, showing size.of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------- -------------------------- -- ---------------------------------------- DATE------------------------------------------------------------ REVIEWED BY ----------- 2 DATE k BUILDING PERMIT ISSUED----- ------ -------- - t �� ----- ---------------- DATE------------ -------•---------------------------------------- Alterationsand/or recommendations:--------------------------------------------------•-------------------------------------------•-•"---------- ---------------------------------.._..---------- ---------------------------- ----------------------------------------- ---------------- ------------•----------- ------------------------------ ----------------------------------------------------------••------------------ -------------------• ----------------------------------------------------------- ------- - s ----------------- ------------ -- ..-------------------------_--- ------------ ----------------------------------- -------------- ------------------------ -'----------`---------------------Date --------------------------------------------------------------- - ----- ', FINAL INSPECTION BY.--- v-------- ---- -------- --- ----- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon 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 3M 3-'63 F.P.CO. -