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F�R OFFI U E: -- ----------- APPLICATION FOR SANITATION PERMIT Permit No. _. ____ __ /l -----------------—---------- -------= ..=a------- (Complete in Duplicate) I Datetssued'a______________ -- ----- ----- - This Permit Ex ares-1-_Year_FromD Issued Date _ Application is hereby, made to the San Joaquin;Local,Heaifh District fora permit-to construct'and install thi work herein described. This application is made in compliance with CountyyOrdin ce,No. 549. L-1 Ape- JOB ADDRESS AND LOCATI N-------- ��' ,, _._T �_- -.-. -----------------------I-------------------•--------= Owner'sName --•- --- ------------------------------------------------------------------------- Phone------------------------------------ Address «one--------------------•--------------- Address ---- ---- - ---- ----- ----- ----------•---------------•-•-----------•---------------------- :. Contractor's Name I� .-- --------�-"'-v---------------------------------•- Phone`: Installation will serve: i Residence Apartment,House,[]--Commercial .❑ .Trailer-Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms _I;_ Number of baths - -__ Lot size __.___. a__.- �d _--______________________ Water Supply: Public system 4 , Community, ❑ Private ❑ Depth to Water Table 31A_ ft. I I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g Hardpan ❑ l Previous Applica+ion..Made: (If yes,date,_- -----------------) No ❑ New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) V Septic Tank: Distance from nearest welt'/.wry._-Distance from foundation____-1a____-_- Material___L --_./ .______________________-___-./J�� No.jof compartments_________a-.____-_-.__Size_r3XS__�C�__� .Liquid depth___��.___...__Capacity___�Q42__Vs - �/ s 1 I /� / - 4 (/ Disposal Field: Distance:from nearest welt/_�r± ._.Distance from foundation_�A__._____Distance to nearest lot line__________._ Number of lines______-___-_-.__- . _h Length of each line /_ _______________Width of trench.______.��_.____.__-________._.__ 1 L �r ype of filter material_'3r_�a -___Depth of filter material------ ��_-_,___._Tata) length---s-------------Z$_____________._ Seepage Pit: Distance to nearest well ____Distance from oundation---,l_Q__�______.Distance to nearest lot line__�___-.-_ ' X Number of pits-- _Lining material . _ �--_� --.-� e � -----Size: Diameter__•�_ _�----- -Depth- --;2�------------/----- Cesspool: Distance from nearest wed_______________Distance from foundation_______,.-----------.Lining materia)-------------------------------------- Size: Diameter__ ---------------s.) --_-De th----------------------------------- ----------Li Liquid Capacity-.❑ � - P ------- 9 p Y- -----------------------. ---gals. Privy: Distance from n 1_.--earest well -----------------_______________________-________-----Distance from nearest building__':______________________ ❑ -Distance to nearest lot line - Remodeling and/or repairing (describe):----------- --- - ------------------------------------------------------•--------=-•------------------------•----------------------------------------- ------------------•------------•-- -----------------------•--------------------- -------------------=--------•---•------•-- •------------------------------------------ ----------------------------•------------------------ =' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S lawsy, and ules and regulations of the San Joaquin Local Health District. 4 [,. (Signed)•--- -- -- --- -- --- ------------------------ (Owner and/or Contractor) • By: -----------------{rt -- ------------ ---- --- --- (Plot plan, showing size of lot, location of system in relation to we uildings, efc., can be placed on reverse side). r i ¢FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY_ . :- -.ter. ------------------- DATE ---------------------------- REVIEWEDBY.------ f---------------------------------------------I--------•-------------------- --------- --------------------------- DATE rBUILDING PERMIT ISSUED------------t---------------------11--------------------------- -------------------------------------- DATE-------------------------------------------- ------------ Alterationsand/or recommendations------------------- ----------------- i - ----------------------------••--•-------------------------•-----------•-----•----•------------------------•---------- I f --------------------------------- ------------------------ - ---------- ---------- ------- ----------------------------------------------------------------------------------------------•------•--••---------- _ -------� ' - -------------------- ------ - - -------------------------------- -- ------------------------------ -------- ----- ------------------------ --------- _._i.._ -- I ------------------------------- --------------------------- ------------------------- ---------- -------------------------------------------------------------------------------------------- ------------------------------- I --------------- ------------------------ ---------------- -- - '---------- - ------- --- ----------------------------------------------------------------------------------------------------------- �-. _ Y FINAL INSPECTION BY:7........ .. . . Date_ = - _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-•63 F.P.CO.