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FOROFFICE USE: ------ ---- " """""" " APPLICATION FOR SANITATION PERMIT Permit No. �fQ,�Jr2_ r, - — - -------------------------------------------- -- (Complete in Duplicate) ..� 5 ________________________ This Permit Expires 1 Year From Date Issued 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 N o. 549. ' a JOBapplication ADDRESS Is made AND L ,n compliance TION withaunty rr.finance orit----- "" it 4 z,--- Q_i_ Q"1" ------ -At"o--- ---- Owner's Name-----=11/"_cC --- - ------------- - --- -------- Phone-------- -------------------------------- Address . , W.1- /✓ j� ;..... ------ --------•--• -----•-----------"-------------•------•---------------------•------ - Contractor's Name !_.4� __ !-..."---•-------"- � ''- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Curt E] Mlotel ❑ Other [] Number of living units: _�_____ Number of bedrooms _ -_ Number of baths _"il�"_ LJ size --------- -�0_.'__ila------ "________________ Water Supply: Public system ❑ Community system ❑ Private [A Depth to Water Table __6--- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay V Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote-----_--------------) No New Construction: Yes 0 No ❑ FHA/VA: Yes No [:] ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) // Material____ ,_ _ .__._ __.____. Septic Tank: Distance from nearest well__7_0.O.histan p from foundation______ - _. No. of compartments-2d4 »Li ui�de th__ r_ _ acit 1.0-©_6. 1 Pq 5ize_r ¢r q P. P Y Disposal Field: Distance from nearest well- .A. Distance from foundation---��{?. __"_"-"_".Distance to nearest lot line"""..511*_"_"_" NY Number of lines________ __ ___ ___ Length of each line idth of trench_._._ _ �� Type of filter materia _ t'.�L_Depth of filter material__, A� _k_____._Total length___- . 4 Seepage Pit: Distance to nearest well----------------------Distance from foundation____________________Distance to nearest lot line____.________.._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------____________"_._-__-__-___ ❑ Size: Diameter--------------------- - --------------Depth--------------------------- ------------Liquid Capacity----------------------------gals. I - Privy: Distance from-nearest well--------------------------- -—`7----- -"---`--"- "._Distance from nearest building--- 9----------------------------------------- ❑ Distance to nearest lot line----------------------- --------------------------------------- ---------------------- - --------•------------------------------------ Remodeling and/or repairing (d scri e):__ _ -------- --------------- � .�. _ - ¢ ---- --- ---------------- --V------------------------------•--•-----------------------------------------------------------------------•---------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------- I hereby certify that I have prepared this application and that +he 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) -h � f�.TV- -------- _.`-----------------------------(Title)------------------------------------- - ---- - -- ---- -------- (Plot plan, shdowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY----------------------------------- DATE--------------- s REVIEWEDBY----------------------------------------------------------------------- DATE----- g--->- ------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------- - --- ------- - — DATE--------_b---- -------------------- --------------------- Alterations and/or recommendations--- ---------------------------- - ----- ------------------•---•------------------------------""------------------ --•------------•-------------------------- ---------- ----- -----------•------------------------------------------------------------ -------------------------•-----------------------•----------------------•-•-------•-----------------------------------.--- -----•-------------------------- -- ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- -----------•------------------------ ----------- ----- --•- -------- -------- ------------------------------- - ------------------------•---------------------- --------- -------------------------- FINAL INSPECTION BY:.. = Date----------- `" ('°� �------------ - - Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street r (� Stockton,California Lodi,California Manteca,California Tracy,California E5-,9�hEV,6 EO 8-59 3M 3-'63 F.F.CO. 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