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-`` _0 I/s-7 .PLICATION FOR SANITATION PERMIT Permit No. __---_---G------_-_-- (Complete in Duplicate] 74t"14 Date Issued _'f/�q-5.--2 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. 49. _ ----------- -------------------------------------------------- JOB ADDRESS ACATIO ------- --------- Owner's Nm -------- - - Q/-----�-- � ----- -------------------------------------- Phon Address--- ------------------ •j_--_ �. Contractor`s Name----------- ---------------------------------- Phone----------------------------------- Installation will serve: Residence 2-_�A_partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__._ Number of bedrooms Number of baths _f-___ Lot size A_ ___________________ Water Supply: Public system ❑ Community system ❑ Private [Er"6epth to Water Tabled_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 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.) eptic Tank: Distance from nearest well_________________Distancef`rom foundation-------------------.Material------.._----------._-__.___________-----_____-- No. of compartments------ Size---------------;_--------------Liquid depth--------------------------Capacity---•------------------- Disposal ield: Distance from nearest well__ r-�` ____Distance from foundation.___/U_- _S_ _.-_-.Distance to nearest lot line__ _-__- EE'_ Number of lines_______________ __ _ Length of each line_ "_f__.____3-3_...... Width of trench.__?�_�"__________________ i Type of filter material___J�_r__ __ _0___ ___Depth of filter material----,��__________Total length__�~___-�---_..-.-______________________ Seepage Pit: Distance to neareO. well----------------------Distance from foundation....................Distance to nearest lot line.-__-_______.._.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________-________..__________-__-. ❑ Size: Diameter--------------------------- -------Depth------ --------------------- --------- --------Liquid Capacity----------------------------gals. N3 Privy: Distance from nearest well---------------------------------------------_--Distance from nearest building--------------.--------------------------- - ❑ Distance to nearest lot line-------- ------- -------------------------------------------•---------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------••---------------------------------------------------- �. I herebyserfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Sante laws, anld rules a�d�regulations of th-e San Joaquin Local Health District. (Signed)----- (. --� (-;!/s. ------ ---- --- --- ----- wner and/or Contractor] By �. ._- �- _. . `` ( )- --- ----- - --------------- :----•-------------------- ------`.. � ...------------------------Title --- -- -- -•--r---------- ---- (Plot plan. showing size of lot, location of system in relation to buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Al-PLICATION ACCEPTED BY----- ------ -- ------ ---------------------------------------------------------------- DATE--------------- /` A ------------------- -----------------------_ ---------- REVIEWED BY--------------------------------- ---------- ---- --- --------------------------------------------------------------•--• DATE BUILDING PERMIT ISSUED -- -- -- DATE__----------- -�� _ _ Alterations and/or recommendations -------- -----------------------------------------------------:------------------ ---•-------------•-•------ ......------------------------ ,--c-- ----------• -•------ ' -tt °G �' ,'' 1�• �''' `-'=�� ;rf ----------------- ------ ----------------------------- ----------- ----------------------------------- �= -------------- --------------------------- ---------------•------------ -.--J---�` �i- ,�.e r.------ "--------------------------------------------------------------------------------------- ---------------------- ---------------------- ---------------------------------- ------•-- ------------------------------ FINAL INSPECTION BY:.------- --R --------------------------------- Date----------- � y ------------------------ U SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised 1.57 F.P.CO.