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FOR OFFICE USE: - --- -- ` _____-_ APPLICATION FOR SANITATION PERMIT Permit No. .1 ----- (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. i . This application is made in compliance with County Ordinance No. 549. I - 9 p JOB ADDRESS AND 3LOAT1,10. 0- .J-_1- ---- --------------------------------------------- Owner's Name -------------------------------------------- Address ----------- Phone •"-.. Address------------------------ - Q `L�'>Fa Contractor's Name------- r ... Phone_ "p ._ ----------- ---------------- ---:------------------------ -_12.�i'_ - Installation will serve! Residence Apartment House E]. Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _��,,,_ Number of bedrooms _,.- Number of baths _� .. Lot size42S7; ---------•-------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _415,ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0< Hardpan ❑ ; Previous Application Made: (If yes,date__--__--_----_--__-) No New Construction: Yes ❑ No X FHA/VA:.Yes E] No.X 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_______________F Distance from foundation------------------- Materia!___.__._______.__ El ?CI$11 No. of compartments--- --------------------- Size------------ -----•Liquid depth ------------- ------Capacity---------- ------ I Disposal Field: Distance from nearest well__.-_________-_Distance from foundation,-------------------_Distance to nearest lot line________ ❑a,S11A47 dumber of fines----------------------------------Length of each line-----------------------------.Width of french.--------•"""-- --------- kjj .Type of filter material-------------------------Depth of.filter material-----------------------Total length_----------------:_-•------ Seepage Pit: Distance to nearest weII_V_v0-yam____Distance from foundation____1_Q-k--------Dis__ _a'n y to nearest lot line___, ----- ROD Number of pits_�___:._�:.___.______Lining material-_-l�i�_l1�".Size: Diameter....... __De � Cesspool: Distance from nearest well_________________Distance from foundafion_ --------------- Lining material-_-___-_._______________-_..________- U' ❑ Size: Diameter---I------------ ---------------------Depth-----------------------------------r --------Liquid..Capacity-------------------------•-gals. Privy: Distance from nearest well----.---------------------------------------------Distance from nearest building ❑ Distance to nearest ]of line--------- Remo deling -------Remodeling and/or repairing:(describe):--_"__ F- ___ -"". {�[A� --••------------------------------•--------------------------I ---------------------------------------- --------------------------------------- t i. . --- ------------------- ------------------------------------------------ - --- -------------•-------------------------------- . ------- '--------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----z__-- A _L _ _ _ _ - ------------- ----------------------- BY�---'=-------'--• �--- � ---------------------------------------- er an r on r ct Title ! (Plot plan, showing_size of lot, location of ystem in relation to wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - a---- ------------------ DATE------ a REVIEWED 8Y = ----- DATE BUILDING PERMIT ISSUED-----------•-----Y------------- =---------- --=---------------------------------- DAZE--------------- ------------------- _ Afterations and/or recommendations::______ - R -- ------------------------------------------------------- ----------------------------------... __________------------------------------------- __ 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 +I ES 9 REVISED 0-59 3M 3`63 F.P.CI7.