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_ FPR OFFICE USE: Xle dl _ _. . ....... _ - APPLICATION RFOR SANITATION PERMIT Permit No. . __, ...... .�-' -----=-I----- ----------- �- (Complete in Duplicate) - . 'hate 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. JOB ADDRESS AND LOCATION-----J,f __F . ----�-- - Owner's Name- -f - ---- .4-------------------------------- ------------ Phone------------------------------------ Address.......S;L�.Q.7- _ Contractor's Name__ ......... __ _ __.__ Phone___________________________ Installation will serve: Residence ,Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units f r �___ Number of bedrooms`:___ Number of baths___ tot size --��_,�----��-�__________._________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay � Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date____________________) No New Construction: Yes 2--No ❑ FHA/VA: Yes ❑ No Z__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep , k; `Distance from nearest well__________ _____Distance from foundation-------------------Material_.____________-____-_____.____-______...______- No. of compartments--------------------------Size-------•------------------------Liquid depth-_ _-_Capacity---------------------- Disposal Field: Distance from nearest well__ _ _._____Distance from foundation_,/1l. __ �_____.__Distance to nearest lot lineU`_______..._. __—_.- Number of lines------.2 ___ ______________Length of each line._--- --.- -_-------.Width of french---- ----------------- �f1 Type of filter material f7itYlr•_,__Depth of filter material__/S__ti_.________Total length____, 511)___`_____________________ Seepag it: Distance to neares well____':-_____.___Distance from foundation__ji).._.._.___.Distance to nearest lot line--.AS---------- A, i IT Number of pits-.--Y- material _i!.-Gr_Ce__«---Size: Diameter___13.3. .____Depth__--- -______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.________-__.__________________..__. ❑ Size: Diameter--- - ------------ ---- ------------Depth----------------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------_-------------- !---------------------Distance from nearest building_________________________________..____._. d ❑ 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, State laws, and rules: d regul ions of the San Joaquin Local Health District. -------------------------- ----------------------- Owner and/or Contractor h --------- (Signed) --- ---- - ------ { / I BY . -i------ {Title} - - --- - (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----------- - -------- ------ s--------------------_----------------------- DATE-----------`-O:jle-fes-9e------------------------ REVIEWEDBY------------------------------------------------------------------ -------------------------------------------------------- DATE--------------------- ------------------------------------ BUILDING PERMIT ISSUED---------------------------------- ---------------------------___ --------------------•------------ DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------- -------------------------------------------- ----------------------------_•- ------------------------------ ---------- ---------------------------------------------------------------------------------------- ------------------•-------------------------------------- --------- i ------------------------------------------%----------------------------------------- -- -----------------------------------------------------------------------------------------• -- ------------- ---------- --- -------- - •----------- ------------------------------ ------------------------------ ------ ----------- ------ R FINAL INSPECTION BY:_,.__....,_``'- ,.C- -,f Y--------------------- Date--.- . ---- S N JOAQUIN LOCAL HEALTH DIST T 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3-'63 F.P.Cq.