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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --- ----- ------ ------ --- (Complete in Duplicate) y/ /� w.,.� Date Issued ----- rL_-------- ---------------------------------------------- _______.___.___ - 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. -A- 3 JOB ADDRESS AND LOCATION -1...- '1_71_�-----;Z- '--.... 7!5i� j� �� ----------------------------•---- Owner's Name -------Lc t�Z C,----=----ft----------------------------------------------------------------------- Phone ------------- -----------------••-- Add-------------- G am ' •----•---------------------------------------- ------------•-••---------•------- ••-•--•----------- Contractor's Name -------- ��________________ _____ Phone' G: Installation will serve: Residence 'g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .l__ANumber of bedrooms _,,_A_ _ Number of baths __/... Lot size _ -_- :2.v ___________•.-.-•-•.____--_ Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe& Hardpan ❑ r 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 availa6le within,200 feet.) y Septic Tank: Distance from nearest welL_�_t__ Distance from foundation ---- 4�_`_._ Material ----��'d�'�+-___.___. `� ® No. of compartments_______fJ'`:.___._..:_Size___ 3_..n 'Y ____Liquid depth ------ ��.. ____Capauty..��_�" Disposal Field: Distance from nearest well._ 4_~_Distance from foundation ----- /1�n"'-.Distance to nearest Iq}-line-_?S. ` ® Number of lines`______:_ -__.______.________ Length of each line_ 3.4fe �-y/;roG�dth of trench_.._ .- ___ ��' ________________ Type of filter material__,/?tVe-,L-------- Depth of filter material ---- j4F'_'........ Total length____________________________ Seepage Pit: Distance to nearest well..____________________Distance from foundation __--_______________.Distance to nearest lot line ----------------- ❑ Number of pits ---------------------- Lining material ---------- .------- ____-Size: Diameter ----------------------- Depth --------------------___.--------- Cesspool: Distance f,•om nearest well --------- _..... ___Distance from foundation -------------------- Lining material ___-________.____________________-_. i❑ Size: Diameter-`------------------------------------Depth.-----------------:--------------------------------_Liquid Capacity ---------------------------- g Privy: Distance from nearest well ----------------------------- _______________^__._Distance from nearest building ------------------------------------- __._. ❑ Distance to nearest lot line .----------------------------------------------------------------- ---------------------------------------------•-•--------------=--- Remodelingand/or repairing (describe)-----------------------------------------------------•---------------------•-•-----------------•---•--------------•---•-------------------------------. i --------------------------------------•----------------------------------•-------------------•-- ----------------------------------------------------------------------•------------------------------------------------- - 1 -----------------------------------------------•--=--------- ------....------------•---------------------------•------------•---•----•--••-----------------------------------------------•--------------------------•--------- � i -------------------------------------------------------•--....--------•---------•------------• `----------------------------------------------------------•-•-------------------------------•-------------------------------- 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 tine San Joaquin Local Health District. (Signed) ?-L---- - -----------------•--•-----------------------------------•------------(Owner and/or Contractor) -- (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 --- - ---U--- - ------- REVIEWEDBY----------------F---------------------'1-'----------------------------------------------------------------------------- DATE-..--------- ---.-..---------------------------------------- 1. BUILDING PERMIT ISSUED----------- -- - - . -- ------ DATE ---------------------------------------------------------- Alterations and/ot -recommendationis: ={- ----- �. : --------------- - - _..------------------------------------------ ' - Y -------------------------- _------- ___--------------------------------------------- .------------------------ ...................... .----------------------------------------------------------------- FINAL INSPECTION BY: ��/ Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, callfornia Manteca, California Tracy, California ES -9 REVISED 0.59 r.P.00. 2M 6-60