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R PFFIJEE USE:fal 6 --------------------- r; APPLICATION FOR SANITATION PERMIT Permit No. r, -_ .-,,e" (Complete in Duplicate) ?� � 6 *-— -"-----. .� 'This Per it Expires 1 Year From Date Issued Date Issued Application is hereby made-to the San Joaquin L al/Healfh District for a permit to construct and install the work herein described. This application is madewin-compliance with Coun �Qrd.it;ance No. 549. - JOB ADDRESS AND LO ATION------/ - --- ------------- - .¢- � y : ._ Owner's Name------ -- - -� ----------- = Phone=/�j�Q Address = - --- ---t -------- Contractor's ----Contractor's Name r -- - -------- --/ ------ --``------------------------------------------------------------------------- Phone----------------------------------- Installation will serve Residence [rv}� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of li�ing units: _/__ Number of bedrooms_ Number of baths J_____ Lot size Water Supply: P�bli.c system Community system .❑ Private ❑ Depth to Water Table aft. 4 Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ 5sndy Loam ❑ Clay Loam [] Clay ❑ Adobe [ - ardpan ❑ Previous Application Made: (It yes,daate_'� 40_J N New Construction: Yes ❑ No FHA/VA: Yes ❑ No�� TYPE OF INSTALLATION AND SPECIFICATIONS: �/. S4 (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) m Septic Tank: Distance-fronearest well---- _s . _--____Distance from foundation---------------____.Material-..___"__-__._.---------------------------------- ❑ No. of compartments------------------- ------Size----------------------------•---Liquid dept---------- ---------------Capacity-------- r7: Disposal. Field: Distance from nearest well_� ��Distance from foundation_-- 0-__.___.Distance to nearest lot line___d�__-__-______' i umber of lines----- ___----i__ _____________Le, th of each line____ v Width of trent �� ypG,hDepth of filter material_ ---��--_ -_Total length------ --a/•-----------`-_-------- F e of filter material_ Seepa 'Pit: Distance to nearest weli____.� Distance from foundation--- +0__.___ Distance to nearest lot line_ -------- N4;mber .____._{dumber of pits. Lining material--''O-G---e...Size: D1ameter_s Y_"_ ___ "- _ Depth_CX)__j_ i_ Cesspool: Distance from nearest well-_,-,---- ------Distance from foundation-----t_ `._______.Lining material_______________ __________________ ❑ ize: Diar_raeter--------------------------------------Depth---------------------- --„-------------r--------Liquid Capacity-,--------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance Grri,nearest building--------------------•--------------------. ❑ Distance to nearest lot line-'- ------------------------------------------------------------- ----------------------------------------------- Remodeling ------------------------•--------------------Remodeling and/or repairing (describe): ---- -- -- - - ----- -•----�y 'I'"f�fijJ i ------------•--•-------------------------------------------------------------------- - ----•------------------------- ----------------------------------"---------------------------------------------------- • 3 •---------------•------------•------------------------------------------------------------------------------------------------ . R -------------------------------••---------------------------------------------------------------------- ------------------------ hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State Iaw s a d rules artd egulations of the"San Joaquin Local Health Distric#.z D!J I (Signed) --------- ----------------------------------------------------- _(Owner and/or Contractor) �! ` s, By------------------------ -• - --f.- ------------ ------------------------- -- -----------{Title}----(.,.�.' ---- - ---- - - •------- ------- 4111 ---- (Plot plan, showing�� of lot, location of systeaa�rt reiation.to wells, buildings, etc.,,can,be.placed on reverse side). �N FOR DEPART NT USE ONLY k APPLICATION ACCEPTED BY -- ------- --- ------------------------ DATE--/, - -- --- REVIEWED BY --- -- ---------- ---=- --- DATE BUILDING PERMIT-ISSUED--------------- ----------------------- ------- DATE---- -------------------------------- Al+erations and/or recommendations:._._ .______ � � / J -----------------------•---•-------------•---------------------------- --------------•-----------'-----------;--------------- ---- ----.-----•-----------•----------------- f s. -- ----------------------------------------- ---•------------ ------------------------ --------------------------------------------------------------------------- F ry ---- ---------- FINAL INSPECTION - -- - ---- _ - . ... k, ---- ---- - - t SA OAQUIN AL 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 ES 9 REVISED B-59 3M 3-'63 F.P.CO.