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APPLICATION FOR SANITATION PERMIT Permit No. _...1.....�.._.... (Complete in Duplicate) Date Issued Date Issued This Permit Expires 1 Year From _ 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. I JOB ADDRESS AND LOCATION-----3771--''c--0'x---Nol1__PVr _t--------—TM_ ---•-•-------------------------------------------------------------------------------- Owner's Name Ian- GiAllet- ---------------------------------------- Phone-R.�la 9L.----••----- ---------------------------- - Address--------------------------------------------------3773- S__9— -----------------------------•------------------------.._...---------....----------_....---•-------------------------...__.- Contractor`s Name---�g- W-&_19.9T_Ae'atxC-- ------ ------ -•-----------------------------I------ Phone-- M..2T046_...-------- Installation will serve: ResidenceXE Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-Z--- Number of bedrooms -------- Number of baths 1-.--- Lot size _1-.---M-1-Acre-------------------------------- Water Supply: Public system U Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IY Hardpan ❑ Previous Application Made: Yes ❑ 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.) I Septic Tank: Distance from nearest well-----------------Distance from foundation------------------..Material-----..---------___--_-____-------_--.._---.-. Lixis,ti.ng No. of compartments--------------------------Size-..--_-----------------------Liquid line depth--------------------------Capacity-•----------------_-_-_---- -- Dispasal Field: Distance f t well - f7---- at - �----_-----.Distance to nearest lot line_---5t INumberr of ines--- - � - -- ___Length of each e -i�--..-------. Width of trench.____._--Z4............. Type of filter matenal__Se_PA---11" Depth of filter matenaL-2.2--------------Total length-AW----------- -_-_---__._---------_<---------- \j Seepage Seep ge Pit: Distance to ret well -- Distance from foundation Distance to nearest lot l-ne----- ------ ERxistingNumberof pits - Lnngm +ral - Size: pQpt - -- -- Cesspool: # Distance from nearest well-----------------Distance from foundation-----r.___.-------..Lining material-_--.--_.----------.--------_----_--. ❑ Size: Diameter--------------------------------------Dept'h_----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------.----------------------Distance from nearest building-...-...-----------_-----__________----. ❑ Distance to nearest lot line-------------------------------------------- ------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe):-----------------------------------------------------•-•-•---------------------------------------------------------------------------------------------- SUPTTARY DRAINAGE °t ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 andregulations of the San Joaquin Local Health District. & NIC_3T Septic Tank' ( r Contractor) (Signed)--The-.-DAY Title - BY --- ---------------------------------- -- --- - --- ----------- --- (Title) (Plot plan, showing size of lot, location of system in re ion to wells, bu' ings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY IE APPLICATION ACCEPTED BY-----1.-_i-R`0--'------------ ---------------- -------- ----------------------------- DATE------- 7'_ �� ----------------------- f REVIEWEDBY--------•---------------------------- ------- ------------------------------------------------------------------------------•- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------- 4 ------- --------------------—------------------------------------• DATE------------------------------------------------------------ Alterations and/or recommendations:-*---------- _------------------— -_.--------- - - --- ----------------- ----------------- ---------------------------------- -- = FINAL INSPECTION BY:-------------- . Date r' - z�------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F.P.Co.