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FQR OFFICE USE: a -- -------------------------------- -�----�----- ------------------ 3;.- APPLICATION FOR SANITATION PERMIT Permit No. _!-_ ------ -- ------- ------------------------- ---- ------- (Complete in Duplicate) Date Issued __G _-- __r_-- --------------------------------------------------------- This Permit Expires 1 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. 549.0� ((�� ,, JOB ADDRESS AND LOCATION.-`71" Owner's Name -_� - -- �// t.&/--- --------------------------------------------- ------ Phone------------------------------------ Addressj1/� (1v ._._.(� 1 ----------------- ------------------------------------------------------------------------------------------- Contractor's Name--•--L-.d-lL� - -- ---- ---"`='- ----- - Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer.Court ❑ �yMotel ❑ Other ❑ Number of living units: :_____ Number of bedrooms ES'___ Number of baths _j-._ Lot size _____15__p_ _/f;�.�___________________________ Water Supply: Public system ®'ommunity system ❑ Private ❑ Depth to Water Table _i_vft. s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No RK New Construction: Yes U;,-1qo ❑ , FHA/VA: Yes ❑ No -� TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep+ic tank or cesspool permitted if public sewer is available within 200 feet.) - l Septic Tank: Distance from nearest well___~'______Distance from foundation-10-__1_-____- lateriai___-_' J�_�'�e�c�� /--..--... No, of compartments_____ 2--__ ' '-- Size----- --�(-� X 9-Liquic�i depth -- Capacity--� - p ^"` _ Distance to nearest lot line_ _____':__-_- Dis Disposal Field: Number ofolines earest well-----------------Distance from foundon._ .-�•• ----------yWidth of trench__-�_�__'�_________-._____-_ Length of each line__ �.5_____.-___-______ Type of filter material___46C.A['-------Depth of filter material_/.I'___`'________r__Total length------jts"la_'_____________________ Seepage Pit: Distance to nearest well------- -----------Distance from foundation..../0.... Distance to nearest lot line__sZ) ©-- Number of pits------- Lining materiale'Tt --_Size: Diameter-_ ., _"-._..-__-Depth-----av_d^_f_______._- Cesspool: Distance from nearest we}l-----------------Distance from foundation___----------------.Lining material-_-_---____________________-___-_-_-_ ❑ Siie: Diameter--------- --- ----------Depth-----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance frgm nearest well-------------------------------------------------Distance from nearest building----------------------------__----_- ❑ Distance to nearest lot I;ne----------------------------------------------------------------------- -------------------------------------------------------- ------------- I. Remodeling and/or repairing (describe): -'---....--•-•----------------------- --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------:---------------------------------------------------- s ---------------------------------------------------------------------•---------------------•--• ----------------------------------------- ----------------------------------------------------------------------------------- V, ------------------------------------ ------------------- --------•------------•----------------------------------------------------------------------------------------------------------------------------------------------- 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 Health District. (Awnerar¢fo* Con+rac+or)(Signed)By:------ ---------------------------------------------------------------------------(Ti+le)-------------- ------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ .......... ---------------------------------------------------•---- DATE------ REVIEWEDBY------------------------------------------ -- •---- -------------,-------------- ---------------------------r--- ------------ DATE------------------------------------------------------------ . BUILDINGPERMIT ISSUED------------------- ---------------------------------------------------------------------------------- DATE.------------------------------------------------------------ Alterations and/or recomrnen ti ns: .......--�r/�-�,J-l--------- � - ----- --- ---------- ---------- ------ Xt_ r-- FINAL INSPECTION BY:------- /------ --- ----`�Iti.�J Date ----- ------ -• -------------------- ------------------------ / SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod],California Manteca,California Tracy,California ES 9 REVISED B-59 31A 3-'63 F.P.Ca.