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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ........•--......_--•-•- _______________________________________________________ (Complete in Duplicate) Date Issued -------------------_-------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordina a No. 9. B AD a PP 41 L JO DRESS AND LOCATION-----•- ��3_C�------- --------------- N•� Owner's Name--------------221U�---�+LL1F------ ----------------- --------- - 7 Phone. ! "`'�_if�r- i -----------•---------•--- --------------------------------------•------................ je-2. - .......... Contractor's Name.<�71:�.....-- •-----•••. - •••-- ---• .. �.� �' Phone Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___. Number of bedrooms ___Z.—Rumber of baths L._.Lot,size _,.(d -cs-f Ak--- 0,15 -d--.'"''--- Water Supply: Public system Uj _<ommunity system ❑ Private ❑ Depth to Water Table Q ft. Gravel Sand Loam Clay Loam' Clb ❑ dobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ y ❑ Y ❑ Y �'` 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-wi+hin 200 feet.) S c Distance from nearest well_________________Distance from foundation_____________-____.Material__________-_____-___________.---------------- . • . No. of compartments---------- - ---- --4Size ----- ----- ------Liquid depth--------------------------Capacity----------------------- f --•-------------••--- sal rd: Distance from near st well Distance from fo�tndat ------------Distance to nearest lot line---,........... Number of lines___ 11 _ _ ____Length of each line_:' e�__� .��.�Nidth of tref h�_�-- __-._. . Type of filter material of filter materia_____'__-_��_____Total lengtli_-�Gzl._ Seepage Pit- Distance to nearest well__;4,V? 4J_____Distanc from foundation-3__O______.Distance to nearest lot line---- �P__._ S„ �� Number of pits___.----------------Lining mater ial_____ _:_ -----Size: Diameter__ -"____Depth__a �_..__-________._ J Cesspool: Distance from nearest well-----------------Distance from undation_____.____________..Lining material__________________________-__________ ❑ 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):------------------ ---------------------------_-------------------------•----------------•----•-------------------•---------------------•-••-------- ---------------------•••-------•---•• ------------------------------------------------- - ---------------- ------......---- 1 -------------------------- ----------------- ---- ------ 4"'' ---------------------------------_•----------------------------------------- I hereby certify that I a e prepared this applicati n and that the work will be done in accordance with San Joaquin County ordinance t e lawrnrules d regulations of the San Joa Local Health District. (Signed) ------- or Contractor) By: (Title)__ (Plot plan, showing size of lot, location of system in relation wells, building etc., can be placed on reverseside). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- - ------------------------------------------------------------- DATE---- -------------------------- REVIEWEDBY--------------------------------------------- ----------------------------------------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------•---------•- -------------------- DATE----------------------------------------------------------- Alterati ns and/or recommendations:___IL�_�_1 _ _Lo --------ls ---1- ,.r ,c."tm11---- ----------� .- -- -•---..._.- -•--•_•_�- ,-+-------_••--------�i----A- ------•-------------------------------------------•----•--•--•--;•------••----------------...------------------------•--------•-- --------------------------•-------•----------------------------------- -----------------------------•-----------------------------------------------------------------------------•-----------------•-•----------------•-- -----•------------ ------------ ---------•----------------------------------------------------- ------------------------------------ -----------------------•--- ----------••---• ------------------ --•-------------- ------------ --------•-•----------------- -------- •---•---------------------------- -----------•-- •------------------------•-------------------•---------------------•------ --------------•------•--------- FINALINSPECTION BY:---0-- ------------------------ ----------- Date------- -Z'- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEQ 8-59 3M 3-'63 F.P.CC.