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FOR OFFICE USE: 4 v O _________________________________________________________ -------------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .__��-5 -------------------------------------- ------------------ (Complete P Duplicate) Date issued Com ete In p ) Date issued ------------------------------------------------------ _ - This Permit Expires_1 Year _ Application is hereby made to the Son Joaquin Local Healfh 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 LOCATION. -- - ----- wP ._------ �1 [ ----------•---------------- Owner's Name--------- P�,� -- - ----"}=33----•--- .• -- -• --.��1___�l P.- - Phone--�..........• -----•--------------- Address------------ :�� '` �' ---�-?l--------------••---- -----••----------- ----------------------------------------------------------------------------------- Contractor's Name--- ^R?'?' "----•-------------_---------------- _.............. Phone............................ ---- Installation will serve: Residence [B Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑] Number of living units: .-+.-__ Number of bedrooms -__ Number of baths J____ Lot sizk t '� 5_ySL `_. s3=1. __.__._______ Water Supply: Public system ❑ Community system ❑ Private Rd Depth to Water Table _ Q__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ,Sandy Loam] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ .:. .Previous Application Made:-.(1f yes,date_ ----------- ._)TNoX New.CorasFruction: .Yes ] sNo.r[] FHA/VA:-Yes ❑, -j4o,❑� 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__- Distance fr m foundation_`-_/_ .____.Mater•sal---efCy�--------------- ---------- Nfl No. of compartments_ �-------------_`_Size_31�_ -'t---- -------Liquid depth_------y---------------Capacity---00---------- Disposal Field: Distance from nearest well_cSO----------Distance from foundation__ ----__Distance to nearest ipt line-4-----_____-- ] Number of lines------J•------------------------Length-of each-.li =--------------.Width of trench-------_--_A�A_'----------------- Type of filter material 42he/-___Depth of filtermaterial__-�?!'_____.__._Total length_-_1Go_'_--___- . ________________ Seepage Pit: Distance to nearest we L=____---------------Distance from foundation____ _____________Distance to nearest lot line----------------- 171 Number of pits---------------------Lining.material----------------------Size: Diameter------------------.____.Depth-_------_._-_----.--------------_ i n Cesspool: Distance from nearest we#I______ _____.__Distance from foundation--------------------Lining material.----------------______-_________. ❑ Size: Diameter--------------------------------------Depth------------.----------------------------------- ---Liquid Capacity---------------------- ---gals. 7 Privy: Distance from nearest well-----___------------------_----------------------Distance from nearest building__------------------------------------C/% ❑ Distance to nearest lot line--------------------------------------- ------------------- Remodeling and/or repairing (describe)-------------_______1_------- ---------------------------------------------------------- -- S ---- -------------------------- ----------------- ---------------------------------------------- ------------------------------ # - •---- ------------------------••- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, �State yhaws, and ules and reg�nons�f a San Joaquin Local Health District. (Signed)-- _ � �-!---- -------------------------•------------------------------------------------P---------------------=--------------f-•-------------------(Owner and/or Contractor) sy=--------•------------------------------------ -------------- -- { ttle) F --- -- -- ---- --- -------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can bi3 placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED- ---------------------------------------------------------- DATE------ ------------------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------ Alterations and/or recommendations:------------------------- ----------•-------------------------- ------- --------- -------•-- -----------•-------- -------------------------------------------------------------------------------------------------------------------------------------------------•--,--------------•--••------------- --------------------------------------------------- ---------------------------------------------------- ------------------------------ -- - ----------------- ---------I------- -------- -----------------------•-------•- ---------------- -•---- -. -----------•----------•-----•--- -----------•------------------------------------------------- FINAL INSPECTION BY:--- - -- •------ ------------ Date .~ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED B-59 3M 3-'63 F.F.120. i i