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FOR OFFICE USE: --------------------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. . �7_ � ------------- _----------------------- --------..---.. (Complete in.Duplicate) ----------- ----------------- This Permit Expires 1 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 AND LOATfON__'; i -_--- c'* -- K-r_�Cct-O _ - y f --------------------------------------- Owner's Name_________________ . 1 ._ •------------------------------------------------ Phone-------------- -----.. .- � � h t ` Address r 'r'U 1 z-�-------- --------------------•-- Contractor's Name........ _.....lir_____._______._ _ - -----••--------------------------------•--------------------------••--- -------•-- Phone. .................... Installation will serve: Residence X Apar e t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms ._ --- Number of-baths ---I--- Lot size _ 1� _ ____. . _ �^q-,!-_•--_ Water Supply: Public system ❑ Community system ❑ Private 0( Depth to Water Table _:�w2ft, CJ Character of soil to a depth of 3 feet: ".Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ "Clay � Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------,__. -------) No New Construction: Yes ❑.I No)4 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: X (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-)_p --±Distan e from foundation_-__1P------- Mat ri l..- _--- � - -- ------ No. of compartments---- --------------Size__7kS_X_).0D__Liquid depth-----�-, -s--______Capacity ----____-- € _ J Disposal Field: Distance from nearest well-_1��_ Distance from foundation.__ _ ------_Distance to nearest lot line--' J Number of w fines-----j------------------------ . Length, of each.line--_/,0.0---7/--------Width of trench____��" Type of filter-material;1° � Depth"of filter,material__-19___._--. _ ____________•.- Total length/WO ------------------------------ Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------------------.Distance to nearest lot line---___-.-----__- ❑ Number of pits---.------------------Lining material-----------------------Size: Diameter------------------------Dept h-------------------------------_- Cesspool• Distance from .nearest well-----------------Distance from foundation...-----------------Lining material.------------------------------------- El Size. Diameter--------------------------------------Depth---•- ---------------- ------------------------------Liquid Capacity------------------------------gals. Privy Distance from nearest well___ _ _______ _ Distance froir,-nearest building ------------------------------------ ❑ Distance to nearest lot line ----------------------------- Remodeling and/or repairing (describe)----------- ----------- ------=---------- t -•------------ --------------•---•-- T ---------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------•--•--------------------• - - I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of theanJoaquin Local Health District. (Signed) -_------- f (Owner and/or Contract ---- SY= ------ ------------------------------------------------------------------(Title_) ----------" -------------- - -- or (Plot 'Plan, showing size of lot, lo,a+it "of;system in relation to welts, buildings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -=" - ---- --------------------------------------------------------- DATE--------------- REVIEWEDBY------ ------- ------------------------------------------------------------------------------------ ------ DATE BUILDING PERMIT ISSUED------------------------- -— = DATE= Alterations and/or recommendations------------------- -- -------------------=-•----- -"-------------- ---- --- ------•-----------=----•----------•--------•- - -•-----------•----------- -------------------- ------------------------------ FINAL INSPECTION BY:----- ------------ ----- Date-- /- _.-�.�. . --- -------------- ---- .---- " ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California E5 9 REVISED 8-59 31A 3-'63 F.P.CO.