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FOR OFFICE USE: f 1(da L t - 6 J ---- -------------------------------- ---------- i ______________________ APPLICATION FOR SANITATION PERMIT Permit No. ._1.... .... --------------------------------------------------------- (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. 1 JOB ADDRESS AND � LOCATION----/111--- a, ----gin------- Ji ---------------------------------------------------------- Owner's Name.-.-_L<T?-..'i---zvt-la ax------------------------------------------------ -------------------------------------------- Address........_._........ -------------------------------------------Address---•-----------------•- -----•. Contractor's -/4r1---- � —---------------- Phone-,, Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._--- Number of bedrooms Number of baths I----- Lot size _... f-'x-.--> Q- --'--------------- Water Supply: Public system ❑ Community system ❑ Privat Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej Hardpan ❑ Previous Application Made: (If yes,date--------------------) No fw_l_ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub is sewer is available within 200 feet.) Septic Tank: Distance from nearest well O-i--.--Distance from foundation�,P--op-------Material........ ---- No. of P. Liquid d qartments--- compartments --------------- �"e_J1 �.---Lie th-_.--wt-."------Capacity , Size_ Disposal Field: Distance from nearest well.-6-Q-----Distance from foundation-__4//.._' P....Distance to nearest lot line--_•,$_!-__- Number of lines---- ---_-----------------------Len th of each -----------.Width of trench----- Type of filter maferial�r Depth of filter material-_-_ X._Y--.__TofaI length------------------ --*---------- Seepage Pit: Distance to nearest 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------------------------------------- 17-1 Size: Diameter------ --------------- -- -------Depth--------------------------- ------Liquid Capacity.---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-1 ----------- _.----___-----------.-. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------ _------ --------------Remodeling and/or repairing (describe)------------------------------ -----------------------------------------------------------------------•---•--------------------...------------------------ ----------------•---------------------------•----•-------------------------•-------------------------•--------------------------------------------------•-----------------------------•-------------------------------------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules land regulations of the San Joaquin Local Health District. ( g )- --------- -q_y_: �1k .0---- —1.27" zre__1------- Si ned --- � --------------- Contractors By:--------------------------------------------------------------- - ------ _ _ {Title].. (Plot plan, showing size of lot, location of system in relation t ells, building etc., can be placed on reverse side]. FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY y DATE REVIEWEDDATE BY---------------- ------- -------- --------- --�----------------------------•-------------------•-------------------- DATE---------•---------•------------• ` ------------------------ BUILDINGPERMIT ISSUED-----•-------------------- ------------------•-•-------------------------•---•-------•--------------. DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------- /�G1 --------- - ------------------------------------------------------ -------- ---- - ----- ----------- --------------------------------- - ----------------- FINAL INSPECTION BY:-------_--- ..----- t �. -----=�--------- - --------- Date----- --------�� - �� --�--� ---------------------------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 6-59 P.P.CO.ZM 6.60