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FOR OFFICE USE: 4 ----------------------------------------------- i�t --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . --------------------------- ----------------------------- (Complete In Duplicate) d1 _-- This Permit Expires 1 Year From Date Issued ` i" Date Issued ---- -/ -- ..�.C.--- 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. :2ffnn3.,. _ 0J(--ltor3s JOB ADDRESS AND OC TION`°---- -----------------={ Owner's Name------- --- .�/�{ •. .. ----- ----- ----- --------------------------- Phone -- ---- Address-------------------------------- ----- ------------------------------------------------------------------ Contractor's Name--•-----------� "_110yt ---------•------•-••-------- -- Phone----------------------------------- Installation will serve: Residence t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4-__- Number of bedrooms -j-- Number of baths Lot size _---�--------------------------•-------- Water Supply: Public system [I Community system ElPrivate. ] Depth to Water Table--,' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam T Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No [e 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.) ------------------------- Septic Tank: Distance from nearest w�--ss'd~ -----_Distanc��o �f�undation----1 d'__---.-.Material_- Liquid depth-------Y--. No. of compartments----- . - � ..-.-_-_-__Ca aci# ��" _____.___ - - ----------- ----Size- --••------ -------- P Y a' line--J G� Dis osal Field: � Distance from nearest well__�r1-_.........,Distance from foundation--- to nearest lot ---.---_.. P Number of lines------3---------------------------Length of each line---k'#---------------------Width of french--- -y-*--.-_-.--.---_---.-- z Type of filter mate ria)f&4...Depth of filter material----j- 4.---------Total length--#'--- --------------------_---- �} Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------_.- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------ .._.Depth--------------.----_----------- 9 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------.-.--__------___--------.-t� ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------;Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------- -7-I--------Distance from nearest building-------.---------__--_------------------- 9� ❑ Distance to nearest lot line--------------------- --------------- -------------------------------------------•---------------------------------------------------------` Remodeling and/or repairing (clescribei:--------------- --- -------------------------------------••--------•-------------------------------------------------------- • _....► - ----------------- ------------------------------ 4 ------------------------ ------- - --------- ------ ------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared,this-application and that the work will be done in accordance with San Joaquin County �f ordinances, State laws. and rules ands egulations of the San Joaquin Local Health District. n r-----l,1_ <'�--------------- ---------------------------------------------------------- (Owner and/or Contractor] (Signed)--- gy:------------------------------------------------------------------------------------------------------------------------------------Title p (Plot plan, showing size of lot, location of system in relation to wells,-buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- F---------•-------- -- ---------------------------------------- DATE -'�'C��.------------------------------- REVIEWED BY-----------------i------------------- ---- -------------- ------------------------------------------ DATE -------- - --- BUILDINGPERMIT ISSUED--------------------------------------------------------------_-------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------- ---------------•--•-----------------------------------------•--•-----•----------------------------------------------- ---------•------------------------- ------------------------- ----------------------- --------------------------------------------------------------. . ------------------------- --------------------------------------- --------------------------------------------------------•--•------- •--- ----- ---------------- -----•------------•----- ------ ---------------------------- -------------------------------------------------------------------- ----- FINAL INSPECTION BY:.- - ------------------ Date --. ----w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. Soo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 31A 3•163 F.P.CC.