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FOR OFFICE USE: APPLICATION VOR SANITATION PERMIT Permit No. .__Ar___-. -------------------------- ------------------------------ (Complete in Duplicate) 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. p --------------•-----•--------------------------------"-- JOB ADDRESS AND LOCATION - J Owner's Name---------- •-----'� •----------- ------ ------------------------------------- Phone-// �--��---�-/�--•--- Address-------------------------------------—5— ""---------------------------------------------------------------------------------------•----••-----.-....--------------------------------- Contractor's Name----------------------_-------- �- -------•--------------------------------•--•-----------•-------------------- Phone-----------------------_- -------- Installation will serve: Residence fr Apart ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms ___2,_—Number of baths __1___ Lot size -------- ----------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [f Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No�k New Construction: Yes ❑ No E4 FHA/VA: Yes ❑ No R1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well---.----Distance from foundation_____,.,'&-______-Materiai---- -- [9 No. of compartments_..__--___7 -------Size__ Liquid depth-___.___-f -..--______Capacity______---JF'o Disposal Field: Distance from nearest well...___--r.Distance from foundation______2�–_o--_.Distance to nearest lot line________,!'' Number of lines---------------/---------------Length of each line----------- --------.Width of trench---------------iZ -------- Type of filter material-___... Depth of filter material_-__!_-_- "-_Total length---------------e4----I_-_____-_ Seepage Pit: Distance to nearest well__._- ..�----Distance from foundation______/-"_G?_.....Distance to nearest lot line_______!{'_ 24 Number of pits-----------tl-------Lining material__� ------Size: Diameter__-_-�__! .___Depth...... ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__.___..._.__..____._____________.__ ❑ Size: Diameter--------------------------- L-------•Depth----------------------------------------------------Liquid Capacity----------- -------------..gals.t /y Privy: Distance from nearest well-__---------------------------------------------Distance from nearest building----------------------------------._____-- ❑ Distance to nearest lot line--------'------------------------------------------------------------------------------------------------------- - ------------------------ Remodeling and/or repairing (describe):------------------------------------------------------ -----------------------------------------•----{--------------------------------------------------- s' --•------.•--------------------------------------------•------------------•-----------•---------------------------------------------------------------------------------- ---------------------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed) --_._-__--,---_Owner and/or Contractor 11 By: .. ----------------------------------------------•--------ITitle) ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on' reverse side). r-02 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --- ----- fix., ----------------------------------------- DATE----............. j-- --------------- - REVIEWED BY-------------------------------- - ------}-- -------------------------------------------------------------------------- DATE- ---- •------------- ----------- -------------- - -- BUILDING PERMIT ISSUED------------- =--'---------------------------- ------ DATE Alterations and/or recommendations:- ------------- ecommendations: s! .CLdt�P �,2 -------------- ..J-----------------------•---------•------------------------------------------------------------•---------------------•---------------------•--- FINAL INSPECTION BY:___.__ ---------- �¢uyc� ______ Date---- `._L r ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxeltan 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 r.P.CD, t r I'