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U UWCE USE: --- h ------------------------------------------------_________ APPLICATION FOR' SANITATION PERMIT Permit No. 2- --------------------- ----------------------------------- (Complete in Duplicate) 1 -------------- 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 compliancewith County Ordinance No. 549. JOB ADDRESS AND LOCATI N__-JIZ*�_+ 1,�.yty. -' - J)Owner's Name---- n1_ ----------------------------------r ------ ---- Phone-------------- Address AL. �' ` .�- -t-1<sF_A. -----------••------------------ Contractor's Name_ t,t- b::{- 5 —-� k Phone. Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Mote[ ❑ Other ❑ Number of living units: _�____ Number of bedrooms __ _____ Number of baths __ Lot size ___ _________________________ __ _.________.___-__ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to -6fr Table ________ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes ❑ No A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! S •c Distance from nearest well_________________Distance from foundation--------.-----------Material-_____.____-__________--___________.------------ No. of compartments Size Liquid depth--------------- Capacity----------------------- o,sa field: Distance from nearest well_-- Distance from foundation____ -- ------- Aff- -__Distance to nearest lot Number of lines---- -. _ ____` Length of each line----- !_-___"__.Width' of trench--- - ------------ __ ��-- Type of filter material_ Depth of filter material____.__ ______.Total length_____________________07 ---. Seepage Pit: Distance to nearest well-------------- from foundation--------------------Distance to nearest lot line----------------- I ❑ Number of pits--------- ------------Lining material----------------------.Size: Diameter_-----------.--------Depth--------------------------------- Cesspool: Distance from nearest well--------------_Distance from foundation------------_-------Lining material__._-------------------------- _Y._- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well---------- ________________________________Distance from nearest building.______-________________-_.-._____._._. ❑ Distance to nearest lot line------------------------------------------------ Remodeling and/or repairing (describe):------------------------------------------ ---- describe): ---- -----------------•-•--------- --------------------------------------•---------------- I+i --------------------------------------------------------------------------------------------------------- -- --------------- -------------- ---------------------- --------------------------------------------------------------------------------- Ax_. :---------------.,. t. r-------------- ----------- _-._.--- -. --------------------- -------------------------------..-----------------------------------------------•---•------------------••----------- ------------------_------------------------------------. � k I hereby certify that I 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 the San Joaquin Local Heal t District. (Signed)- {115WA �_ar Contractor) By:--------------------------------------------------------------------------------------------- --------- - ----- -------- (Plot plan, showing size of lot, location of system in relation to v0s, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- - lC_ --------------------------------------------- DATE------.--7 -�- - REVIEWED BY DATE BUILDING PERMIT ISSUED------------------ -------------------------------------------—---------------------------.---------- DATE Alterations and/or recommendations-------------------------------- - -------------------------••------------------------------------------------------------ --------------------------------------------------------------------------•-------•-----•------------- -------- ------------------------------------ --------------------•---------------------- ----------------•------------------- •------------------ --------------- FINAL INSPECTIONBY:-.__ � _.- __-- ------ -_w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED S-54 3M 3-'63 F.P.CC.