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FOR OFFICE USE: ---- -- ------------- ----------- -- ------ APPLICATION FOR SANITATION PERMIT Permit No. ------------- ---- ---------------------- ------ (Complete in Duplicate) Date Issued W17 _o��_=____..--- 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-_/ :R_ -I IS-C I Q-------- - --- Lf;-- - ------ ----- � = Owner's Name--------------------------------------------------- ------- ------------------------------------------ Phone------------------------------------ Address ' f ------------" = __V3Contractor's Name---- --- -------- wL( ' r j- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f.---- Number of bedrooms_. Number of baths -f--- Lot size --_-I�J Re- v----------------------- Water Supply: Public system ❑ Community system X" Private ❑ Depth to Water Table 1.f.---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.-------------------1 NoX New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 3� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 17 Septic Tank: Distance from nearest well---`7 __-__Distance from foundation_/p----------Material. .0-_ fl- °4 /_' �_._.. No. of compartments.......2,_ l --Liquid depth----.s�/ p y---`- -------------- -- ----------Size------------- --- - __ Ca acit -0--.-_-_--Distance to nearest of line----.- Disposal Field: Distance from nearest weIL.0~P----Distance from foundation____ ----yr Number of lines-_ -__--__ --_--.___---Length of each line_/4-� -___��----.Width of french.--- ._- _ --_ .��-- Type of filter material---� ' .._.Depth of filfar material---- .�'_. __.To#al length----- . __.__ i '_________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.-.---_--_.- ❑ Number of pits------------------ ---Lining material------.--------------- Size: Diameter-------------- --------Depfh-.------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---._-__.------.____-_----.-------.- ❑ Size: Diameter--------------------- -------- -------Depth------------------------- -- -------------------.--Liquid Capacity-..------------------------- Privy: Distance from nearest well--------------------------------------------- Distance from nearesf building_____--..-------------_----....___.__ . ❑ Distance to nearest lot line-- --- ------------------------------------------------------------------------ ------------------------------------------- Remodeling and/or repairing (describe) ---------------------------------� L-- wf s- ` .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 laFlz. nd regulations of the San Joaquin Local Health District. (Signed)------ �. ------------------- -- ---------------- ----------- ---------------------------------.-.(Owner and/or Co41ra_c10 By------------------------------------------------------------------------------------------ -----------------------------------------(Title)--------------------- ---------------------- --- -- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------- DATE-----x9v23'67-- ----------------REVIEWED BY------------------------- -- --- ------ -- ----------------------------------------------------------------------------- DATE------------------------------------------- -�BUILDING PERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE------ --------------------------------------------------- Alterationsand/or recommendations---------------------- ------------------------ -------------------------------------------------------------------------------------------------------------- ---------------------------------- ----------------------------------------- --------------------------------------------------------------------.----------------------------------------------------.-------•-- ------------------------- --------------------------- -•-------------------- ------------- ----------------- ------------------------ -- -----------------------------•----- ---------------------------------- ------------- FINAL INSPECTIO 0300 --- ----- ............... Date_-.....----A70fo�------------------------------------- -------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.H on Ave. West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.