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FOR OFFICE U f? APPLICATION FOR SANITATION PERMIT Permit No. .... .. Q. ------------------------------------- ------------------- (Complete in Duplicate) �Z Date Issued ._.__.�r4l. _______________________ --------------------- 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. JOB ADDRESS ANP L CATION � 3 C .Q�R.CX1' .. Owner's Name- ---- ---V -•--•--••---•---•-----•----•--------------- •----- Phone.................................... Address........................3003./�i'.. /? :0_ ..---------- 11�[ i �'- �'�ktz._ t T Contractor's Name � ----------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence UP-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: __/._ mbar of bedrooms .1Z-. Number of baths ./.. Lot size i _ .t. ..............................• i Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeAr Hardpan ❑ Previous Application Made: (If yes,date___________________) 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 T�a,�nck:1 Distance from nearest well_______ _________Distance from foundation•_._..._..__._.._..Material.------------------------------------------------ ,K;pl7/3j"14 If No. of compartments--------------------------Size............................_ -Liquid depth--------------------------Capacity....................... Dispospl Field: Distance from nearest well_________________Distance from foundation------_.............Distance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of trench................................... Type of filter material-----------_-------------Depth of filter material-_-_--_-__________--__,Total length.......................................... rr Seepage Pit: Distance to nearest well__._��'°'^'......Distance fr m fo dation_.f+ ..__._.Dis ante to nearest line_.S�_._l.. \ �]/' Number of its-_._ ___ Linin materiaL �.Size: Diameter��_�__._._Depth_.`____! _.._____..._ V P /----------- g Cesspool: Distance from nearest well......__---------Distance from foundation--------------------Lining material--__.-_-____-_--_-_____-:_-_-__-___--. w ❑ Size: Diameter-------------------------------------Depth---------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-______.-_____________-_______________________Distance from nearest building.----..................................... ❑ Distance to nearest lot line--- . Remodeling and/or repairing (describe):__________________ ' --------- ---------------------------------------------------•------------•--•------------.----------•-------------------•------•---•------------••--.....•-----------------------------------------------------------.._.__. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulations the San Joaquin Local Health District. (Signed)-------------------------------------- ��-- -- -----�wells, ----------------------------------------------(Owner and/or Contractor) (Plot plan, showing size of lot, location of system relation to buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------C..---- --s---------------------------------------------------------------- DATE--. ---_---------------------- REVIEWEDBY----------------------------------------------------------•---------------------------------------------------------------- DATE............................................................ BUILDINGPERMIT ISSUED..............................................................–...................................... DATE....................................... --------------------- Alterationsand/or recommendations--------------- ------- -------- ---------------------------------•-----------------------•------•-------•--------•----•--•------------------......------. i )S 1u i I ............... ltA.S ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------. ---------------- -----------------------------•-------------------------------------•--------------------------------------------------------- ---------------------------------------...----------------------........----- -----------------------------------------------------------------------------------------•---- --------------•-••-•-----------------•------•---•-•-----•-• ------••---------•---••-••-----_..---•------•--------•----------. FINAL INSPECTION BY:---- ZS-•--------------------------------- Date----- •---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 9.59 F.P.CO.2M 6.60