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FOR OFFICE USE: -------- -------- -------------- :----------------------- ------ ---------------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -- - ----------------------- ----------------------- -- (Complete in Duplicate) - ----------------------------- --------------------- - - This Permit Expires I Year From Date Issued 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 1AND LOCATION.-e --,---AI . ,A-7-<---- ----------------------------------------------- -- --- -- --f9-0---07 Owner's Name--- --------------------------I - -------- ------ ------ Phone--------------- -------------------- --- - Address----------&—.-P -------- ------------------------------------------------------------------------------------------------------------------ ------ Contractor's NameAZ._,f4. --------------- ...... ------------------- Phone--------------------------------- --- Installation will serve: Residence Ej Apartment House E] Commercial El Trailer Court E] Motel El Other F] Number of living units: __1----- Number of bedrooms _2--. Number of baths _-2— Lot size ----- N Water Supply: Public system 0 Community system 0 Private 12 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 5d Clay Loam E] Clay [] Adobe(:] Hardpan 0 Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes [M No E] PHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welI___V_v-------'Distance from foundation----ko'__-------Material---i j------------------------ ® No. of compartments------I------------------Size--If-;!! S-------m---Liquid clepth__._ff-------------------Capacityj>_,�Av---- ------- Disposal Field-, D;sfance from nearest well.;F_V_---------Distance from foundation__!_!_-_--_------Distance to nearest lot line..--X........ 10 Number of iines-__-3 -------------Length of each line------`%I0------------------Width of french------A-4------------------------ (1: Type of filter materiall+__,� A--------Depth of filter material-----LCI-------------Total length-------tAgp.* ------------------------- 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--- ------------------------ -------- El Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy-, Distance from nearest well-----------------_.--_. --------------.....D;sfance from nearest build;ng----------------------------------------- ❑ I Distance to nearest lot line-------------------------- -------------------- --------------------------- Remodeling and/or repairing (describe):-------------------- --------------------------------------------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ --------------------------------------------- -- ---------------------------------------------------------------------------------------I------------------------I...:---------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --------------------------------------------- -------------------------------------------------------------------------- ------ ave pr - re this application a d I hereby Xcerfiff that I have -------------- that the work will be done in accordance with San Joaquin County a T ' ordinances, ws, and rules re lations f the n Joaquin Local Health District. -- --- - -------------- - ---- (Signed� - - - ------ -- ----------r--- -------------------I-------------------------------------------------(Owner and/or Contractor) -- ----- - - ------------------------ --------------------------------------- -----(Title)------- - I------------ (Plot size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY —------------------------------------- APPLICATION ACCEPT! REVIEWEDBY----'------------------------------------------------- ---------------------------------------------------------------------- DATE----------------------- BUILDING PERMIT ISSUED-------------------------- ------ --:-------------------------------------------------------------- DATE Alterations and/or recommendations:----------------*_._.'�-------------- ----------------------------------------------------------------------------------------------------------------- -------------•---- *------------------------------------------------------------------------------ -------------------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------•---•--------- ------------------------ ------------------------------------------------------------------------------------------ ---------------------------------- ----- ---------------------------- - - ---------------------------------------*------------------------------- -----------------------*---------------------------------------------------- ---------------------------------- FINAL INSPECTION BY:.. ------------------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.F.Ca.