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FOR OFFICE USE: _ ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ............: ----------------------- _, --------------- - -------- (Complete in Duplicate) sr / 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 Ordlnance,.,No-,5.49. l 7 l .. fe-1;A JOB ADDRESS AND CAJION - ' ,e ,�`h ;.:: _ Owner's Name------- ._ .: ----- dot--��1-------------------- - Phone--•----------------------- ------- Address------------ /f/ `-' - ------•- Contractors Name______.....1��______________ -------- -- --------------' " Phone Installation will serve- Residers �❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo/tel ❑ Other e&4,- _1 Number of living units: __ Number of bedrooms --- -- Number of baths __I_-__ Lot size ----------14--------------------------------'_----------- Water _--_-.-_._Water Su I • Publics stem Community system PrivateX De th to Water Table/,—;1 t. PP Y• Y ❑ Y Y ❑ P i. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam` Clay E] Adobe E] Hardpan ❑ Previous Application Made: Ilf yes,dote--------------------) No New Construction: Yes � —No ❑ f HA/V•A: Yes ❑ 'INoi TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest well__e%_?�-----Dista ( fro foundation--.-J __-_-___.Ma� al- 1 -_-__-_. � _.-__ 7. CacitY z -_---No. of compartments = -------- i uidde th {�3 Disposal Field: Distance from neareI well_j _ .Distance from foundation ........Distance to nearest lot line._-- -' ..I ' Number of lines------- -----------_-----_-_-.. Length of each line----------- ---SJR.___----.Width of trench__--��'_f-._----_----- � % Type of filter material,, ] Depth of filter material-__f e-___---_-__.Total length--_.-_--_-- -- '� I ' Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line-----li w ❑ Number of pits-------------------'-Lining material---------.------------Size: Diameter-----------------------.Depth--.---------------- ,:---------- Cesspool: Distance from nearest well______-__.___-_Distance from foundation--------------------Lining material-------------------- ! � + Size: Diameter---------------- - - --`-----....Liquid Capacity-..y- .._. ��`I--------- El - - - [] 4 ':--------;Depth --------------- =---------' --'- 99----------------------------�1----gals. Privy. Distance from nearest wel -------------------------------------------------Distance from nearest building ___._----.. o ❑ Distance to nearest lot line---------------°-----. -- Remodeling and/ r repairing (describe) ____. `{ `� J '� �Q—'s'�'�-��"�� li - '�----------- ��) (� _r -ti_.._—_ f__ -.--------------- ------------ t c - ✓ -- �� _- ' I� ------------------ -----'------------- ---- ----•--------•----------------.-------------- -- ---- ------ - II. ---------- ------- ----------------------/�-----------------------------------------------------••----------------------.----------- - .--------------- I hereby certify that I hay prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rd'1:s and regulations of he San Joaquin Local Health District. Owner and/or Co II �--- J (Signed).. -------_ :-- t''r '------ � ( / tractor) sY:----------------------------------------_-------- -•------------------------------------------------ ----------------------------{rifle)------' '------------ (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i. APPLICATIONACCEPTED BY--- ------ ------- ------------•---------------------------------------------------- ------ -- DATE----------------- ----- ---------------- 11 REVIEWEDBY--------------------------------------------- ------------- ----- ��" f; --f-``�-------- ------------- BUILDING PERMIT ISSUED----------------=------------------------------------- - '� ------------- i Alterations and/or recommendations:-------------- --- - --- ----------------------------------------------------------------------------------•--- ------------ I -------------------------------------- ------------------------------------------- -----------------I------------------••-•----------------------------------- --------------- -----------------------------------=------------ -------------------------------------- ----------------•------------------------------------------------------------------------------'------------ ----------- ------------------------------- ------ --------;I ---------------------------- - - " - l� FINAL INSPECTION BY: - Date_ ----- ---------- --- _ 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street ll Stockton,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED B-59 3M 3-'43 P.P.Cq. 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