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FOR OFFICE USE: ------------------------- , 3 .. 2Y ` APPLI ATION FOR SANITATION PERMIT Permit No. ..........�.... ... Q- ,•� (ComDate Issued ... plete in Duplicate) / -------- _._ This Permit Expires 1 Year From Date Issued Appl cation 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 A LOCATION••--•4.1XL ------ s =-r` Owner's Name.... '' � --------- Phon�---- Address........ -�V --------- J ................................................................. Contractor's Name----�U_s-.►--- Phone Installation will serve: Residence% Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __:I. Number of baths ----1. Lot size •----------------------------------------------------------- Water Supply: Public system N Community system ❑ Private ❑ Depth to Water Table,,-5—f__ ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)2 Hardpan ❑ Previous Application Made: (If yes,date-------- No b? New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLION AND SPECIFICATIONS: (No septic tank of cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--..-_______----•_-.Material____-___--_-_.-_ __-_,___--------.---_____.--. E2�—_XlIST No. of compartments--------------------------Size--------------------------------Liquid depth-_---•------------------Capacity....................... Disposal 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____________ ___-----Npth of filter materia -- ----------------l.. ._ Total length.......................................... \ Seepage Pit: 'Distance to nearest w II KIs?,_DistanCe from foundation---10 `� .Distahce to nearest lot line... ' ' Nuri'�ber of pits--------l------------Lin ingw matenal__:: 'Q /,4__Size: Diamete ____�e_1�_G,_.._Depth_____ _ ___________________ Cesspool: Distance !_om nearelt well________________Distance from foundation------------- __...Lining material.__..................................... ❑ Size: Diameter--------------------------------------Depth ------------•----------- -----------------Liquid Capacity gals w, Privy: Distance from nearest well -- --------------------_-----------------Distance from nearest building................ ..`..V.-_.--•__.. [ .. Distance to nearest lot line,----- ..._ Remodeling a'. "or repairing escrib x --------- - -•- ----- ----- -•----------------------------------------•--- -r ------------ •---------..-•-------------------------------------------------------- ------------------------------------------------------•--•---------•--•-•--•----•-------•--------------••-••--••-•-•-•-------------- 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 regulations of-the San Joaquin Local Health District. (Signed)-_'_X------ ----- - ----- ------------- -------------------------- (Owner and/or Contractor) By:--- - ------------------------------------------------- ----- ----- ---•---------------------------------------(Title)---------------------------- ----------- ------- ----- (Plot plan, s owing size of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- - - ----------------=----------;--------------------------------------------------- DATE.. BY----------------------------- --------------------------------------------------------- .......................... DATE........................................................... PERMITISSUED*--------------------------------------------------------------—...................................... DATE------------------------------------------------------------- Alterations and/or recommendations------------- 11 ` == At....................-:2 L AV- --------------- -------------��-----....-- -----------------• ...................... ---------------•------------------------------------• ................................................. FINAL INSPECTION BY:......aa -------- -'s- Date-----V...__1_4- ...... /--------------------------------- 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.F.CD.2M 6.60