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FOR OFFICE USE: y� 5 ----- ------------- Permit No. yyy APPLICATION FOR SANITATION PERMIT 71. 6- ------------I- -'--7- ----- (Complete in Duplica#el Date Issued 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. 6-h JOB ADDRESS AND LOCATIO 1 �� 1�� --------------- ---- !5 ---------------- Phone.-A/ 1° f Owner's Name------------"-"-- ---------- - Address-------------------•---------:�,aa------W.r--------- -------------------------------------•-------------------------------------------------------------------------- Contractor's Name /,S'f,� �"�`-'rte - ----- ---------------------- ------------- Phone-- -- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ 1 �-d--- - Number of living units: ---t--. Number of bedrooms ---)l-__ Number of baths "-"-"-." Lot size- -------k4� Supply: Public system Community system ❑ Private ❑ Depth to Water Table/O-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam 93-1,Clay ❑ Adobe C1 Hardpan ❑ t Previous Application Made: (If yes,date.-__---------------) No New Construction: Yes ❑ No [ FHA/VA: Yes ❑ � No [� 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 from foundation--------.-----------Material_---.-..--.----.___----.f----_----------- ❑ No. of compartments---------- ---------------Size---------------------------- ---Liquid depth.----------- - Capacity----------------------- Disposal Field: Distance from nearest well____-------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines------------------------------ ----Length of each line---------------------------_Width of trench----------------------.------------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well------`_`-------.-----Distance fr m foundation----est-_6'01stance to nearest lot line�� [* Number of pits....-__-----------Lining material--IA411ccl.-Size: Diameter- ?01 -_Depth"_-_r .t'f 0) Cesspool: Distance from nearest well-----------------Distance from foundation... _-.-._...--.Lining material"""______.- _"_""-- "-." 6 ❑ Size: Diameter--------------------------------------Depth--------------------•----------------------- ------Liquid Capacity - ----gals. 0 Distance from nearest buildin C Privy: Distance from nearest well -------- ------- -------------- ------------ ------------ - ----9---------.-------•------.----.----------- G I ❑ Distance to nearest lot line...----------------------------------------- --------------------------- �� J/ + Remodeling and/or repairing describe):---- --' -- ----7�-------•��---X-l"-�-�/��----------�-------=�-�z`--------• ---------•-------• ------------------------------------------------ ----------------------------------------------------6 » r - A. --- -- --------------- ----- ----------------- ------ •------ -------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work wild be done in accordance with San Joaquin aunty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. C-7-> [Signedl -------------- -------------- - w rand/or Contractor ----------- (Title Tit a �' t -dE9 (Plot plan, showing size of lot, location q f system in relation to wells, buildings, etc., can be placed on reverse side). : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�". --------------- �ATE � " -------------------------- REVIEWED BY.--------------- - --------------- ------------------ --------- ----- --------- ---------------------- -- -------------- DATE----------- ----------------------------------------------- ATE ----------------------------------------- BUILDING PERMIT ISSUED------------------------ -----------------------------------------------------------------X-4 ANTE- - - - x - - -Alterations and/or recommendations•--_- f - ---- -_------ 'x1. lam- ��j_ _ - f w - ,... ----- - -- ------------- -----"------'- --------------------------- ---------- 1 / ----------- •-------- ----------- --------------- -------- - -------------- ------------------- -`�FICL INSPECTION BY:....= --•---- - ---- ------------------ --------- Date _ " s 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 �'< F.P.CO.