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6 OR OFFICE/0_Y�------ USE: -At6a24� --------------------------------------- .` /}------ APPLICATION FOR SANITATION PERMIT Permit No .,�..7 .... ai ------------------------------------------ ----- (Complete in Duplicate) Date Issued .. .. _--_ 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 AND LOCATION----------- _ -_-__ . Owner's Name ; t �- �c �- Phone.. , Address_____._ d__ _,�___ - ------- 1= Contractor's Name_________ __ ______ __�______• ......_�__,, i--------------------------------------------------------------- Phone--- Installation will serve: Residence gal'-Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. _ Number.of bedrooms _3____ Number of baths _I-__ Lot size ---------- ------ _C3_-_________________ Water Supply: Public system LR'-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 E�''Hardpan ❑ Previous Application Made: llf yes,date___________________ ) No 0- New Construction: Yes ❑ No ❑"- FHA/VA: Yes ❑• No E�- ' 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--------------------------------------t---------- r No. of compartments-------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- Dispos I Field: Distance from nearest well._. s2_'t_ Distance from foundation-----/..d----------Distance to nearest lot line___... Number of lines----- -- Length of each line_4q_'r --3t2r---Width of trench----- 2- ---------- --- x Type of filter material__ ,*�_k_---Depth of filter material-----e__e----------Total length______2., Seepage Pit: Distance to nearest well___A/'0_2i_-r___Distance from fo ndation----- Distance to nearest lot line___-.`'___.__ [ � Number of pits_-___._.f_____-____Lining material------ - _..Size: Diameter__.4-,?_ ___.._.__Depth-------- r_______________ Cesspool: Distance from nearest well-----------------Distance from foundation__----------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.--------------------------gals, ?,1 Priv Distance from nearest well________________ Distance from nearest buildin J Y g ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------- -------------------------------------------- V1 Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- t ------------------------------------------------------------------------------------------------ --------------------- - ------- -- ------------ ------------------ -----------------------------------------------------o ________________________ _______ _____________________________________________ ____________________________________________________-____________..--____________ ______________________________.______..___--__ -- _ ___________-____.______________________•________________-_________________-_--____-____-__________________________________________________________--__--_____-_---_____________- _._________-________..__..- 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 Joaquin Local Health District.- (SignSi ed) 1 Owner and/or + { 9 ----- � `---------------- --•----- ---------------------------------- { / Contractor) ------------ .�� ._._--- {Title)' " ' ' ----------------- By: (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --------------------------- DATE ' ' ------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------- --------------------------------------- Alterations and/or reco ati ------------------- -_-_ =' --------- --------------------- --------------------------------- `----------------- ' FINAL INSPECTION BY-------------e7 ter'---- -------------------- SAN ------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street' Stockton,California Lodi,California Manteca,California Tracy,California n ES 9 pEVlS&D B-59 3m 3-'63 F.P.p p. � -