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FOR OFFICE USE: ------------ >f . (c '�U..__ APPLICATION FOR SANITATION PERMIT Permit No. ../.. _. ...... ----------------------------------------------------- -- (Complete in Duplicate) - Date Issued Z0 2/�� ------------------------------------...------------------- 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 Ordi an a No. 549. JOB ADDRESS AND LOCATION-----•.... LA-7------------------------------T /1----------------------------------------------------- Owner's Name--------------IMe s------��~ T1----------------------------------------- -------------------------------------- Address -----------------------------------Address ll -----rf........... ...... ....................................................................................................... Contractor's Name-------------------/ .......... -------------------------------------------------------------- Phone../ `? ,i,i®7 Installation will serve: Residence Z Apartment House [ICommercial C] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---____ Number of bedrooms ._�Number of baths __J---- Lot size -_- _--_______________________ Water Supply: Public system g Community system ❑ Private ❑ Depth to Water Table _60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ( Hardpan ❑ Previous Application Made: (If yes,date- ------------------) No C' New Construction: Yes ❑ Nog FHA/VA: Yes ❑ N Z 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----------------------.---.._-_--_--.--..-.-- ❑ eyt_171'V 6 No. of compartments--------------------------Size--------------------------------Liquid depth.-------------------------Capacity------ ---------------- Disposal Field:1r, Distance from nearest wellfvON ._Distance from foundation...../&1-____....Distance to nearest lot lin .__J_--___..... EXIST Number of lines............ ........ .. Length th of each line------- Width of trench..______ .__..._.____... ©' Type of filter material.So__ /� -Depth of filter material-------r______....--Total length________________ _______________________ aQ Seepage Pit: Distance to nearest well----------------_-----Distance from foundation....................Distance to nearest lot line................. ❑ 6y-1,S f'�' Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.----_.---__---._--_____-___---.___. ❑ Size: Diameter--------------------------------- ----Depth---•-------------- •------------- ------------------Liquid Capacity----------•-----------------gals. V1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----------------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------- V Remodeling and/or repairing (describe):_-_&W 9' ------------------------------- -_------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- 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)-. ��.e-k'��shr .1/U C' . ------------Owner and/or Contractor By:-----------. " '' - -----------------------------------------------------(Title)---- -- -- (Plot plan, showing size of lot, (ocatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE -�-------- - ........--------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------- ----------------------------------------------- DATE---------------------------------------------------------- - Alte atio a /or commen ations------- --- ------ - - --- ---- -------- ----------------- -------- -------------------••---•--------•--------------------.------------------------_.... _ _ '.. ----?,�--------------------------- ---------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- --- ----------- ----'---- ----- Date---------- _ ......... -------- ------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.