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FOR OFFICE USE: __ ----------------------__--.. :'u'o APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --------------------------------- ------------------------- This Permit Ex fres i 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 Ordinance No. 549. J,--)?I :I JOB ADDRESS AND TIO *_ ------ 44/�--------------------------------------------------------- G C ------------ .r, Owner's Name ..------ -- Phone------------------------------------ Address----------------•------F .7. Zf� ' -� -----.-ri.�- -------------------------------------------------------------- Contractor's Name---- = d .,S --------------------------------- ---------------_ Phone-- Installation will serve: Residence I& Apartment House []`Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. J---- Number of bedrooms-_ - Number of baths _-I-- Lot size -s ®-x_�- ----X- _�_ Water Supply: Public system ❑ Community, system F-1PrivateIM Depth to Water Table -ill_ ft. 1.Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam JA Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,ddte------------- --1 No [g New Construction. Yes M No ❑ FHA/VA: Yes ❑ No jr i TYPE OF INSTALLATION AND,SPECIFICATIONS: y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e;, Septic Tank: Distance from nearest well__,1f�-----Distanc,e from foundation__/�_------...Material-__-_<1c� IN No: of compartments__.--..- - ------Size_ �.2�' .__:__-Liquid depth_--___-5_10"_____Capacity._��d_--_.-_-- �� Disposal Field: Distance from nearest well_---,l�D-_-_Distance from foundation---��-�---_..Distance #o nearest lot line----------------- Number of lines--=------------- Length of each line------ c7 Jidth of trench___-c9;----fl: ----------------- w --__-,---_------ Type of filter material--- _ �'eh�'_.Depth of filter material---- - -d g A # Total len th f= '�`l 3 Seepage Pit: Distance to nearest well-i-4!qp-.----Distance from foundation_______ ---.Distance to nearest lot Number of pit--------- i: .._`Lining material-__.. _-0ekw..Size: Diameter.__r 3-`...-._.. Depth �>�` _-----_-___---Ix � s Cesspool: Distance from nearest well"--_--- --,.__Distance from foundation--------------------Lining material_________________________-------.---. ' ❑ Size: Diameter------ -------------------------------Depth----------a------------------------- ---------------Liquid Capacity---------------------------gals. Privy: Distance.from nearest well--------------------------------------- ---------Distance from nearest building--------------------------------. - -- ❑ Distance to nearest lot Gne----------------------------------------i------- ------------------------------------------------------------------------------- -------- Remodeling and/or repairing describe] ---_- 5 /L -� ------•---------------------------------- ----------------•------------------- -. r fI ----------------------------------------------------------------------------------------------------- ------- - --------------------------------------------------------------------------------------------------------- 3 ------- - - ----------------------------------------------------------------------------------------- -------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County G ordinances, State law ules and regulations of the San Joaquin Local Health District. (Signed)---------------------- - -�---- / ----- - -•--------------------------------------------------------------- --------Own and/or Contractor) 4- By:_--------- ---- ---- -- -- --- •-r :a.P---------------------------------------------------------------(Title)--------- -- - --- ---,------------------------------------- (Plot plan, showing size o lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY- ---- � ---- DATE-_ 2 � --- ------------- -=----------------------------------------------------------------------- -------------------------------- ------------------------ REVIEWEDBY------------------------ -----=- -------------------------------- ----------------------------------------------------------- DATE---------------------------------- BUILDING PERMIT ISSUED-- --------------a-�6------------------------ DATE----------------------------- ------------------------------ Alteratio s an or recom atio :_- - -_------_ -----A; - / ` ------- a��----------- �-* -- .�` e --------------------------------------- J: ---------------------- --------------- - ---------------- ----- --------------------------------------- ------------- ------------------------------------------------------------------------------------- ------------------------- ---------------- '/�- - /-z lel FINAL INSPECTION BY: Date ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan 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. E E