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' �FFICE USE: 3 r! ------------ ----------9---- APPLICATION FOR SANITATION PERMIT Permit No. .. ..._. __ ------- ----------------------------------------------- Thls Permit Expires 1 Year in Duplicate) -------------- ------------------- - ------- ----------- 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 OCATION- 0 /7 / -- ---------------------- -------------- ----------------------------------= - ---------------------4------•- � i ' Owner's Name------- --------` � 1.l- --T--------•------------------- ---- ---- ----------------------- - ;------ Phone------------------------------------- Address --------- Contractor's Name----- -------------------------- ------------- ------• ------- -------------------------- Phone---- Apartment House ❑ -Comm ----------------------------- Installation will serve: ;Residence -Commercial ❑ Trailer(Court ❑ Motel ❑ Other ❑ Number of living units: _-�,__ Number of bedrooms -- Number of baths _/--_ Lot size -----Sd_-- .�f� __'_-_-_------__---_ Water Supply: Public system �� Co�munity system E] Private E] Depth to Water Tabley�t. , I Character of soil to a depth of 3 feet. i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,ldaie---------------- ----) -No New Construction: Yes ❑ Nopr FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4an : Distance from:nearest well-----------------Distance from foundation-------------------Materia4--------_-.- -------_------------------.__--_--. No. ofcompartencs Size.... Liquid dept `Capacity i al Field: Distance from nearest well_ ._.Distance from foundation_ Distance to nearest lot line--- ------- --- ----------- Number of lines_-_----�--------_ - _Length of each line-------.---3._d �-= _--.Width of trench.___pt-. _-- �� Type of`filter material-_CSL p al length------_- :------:--_- ----••-_-- +y De th�of filter material--- � Tot Seepa e Pit: pistance to nearest well_-__D':stance m fo ndation---,�Q'--_- .Distance to nearest lot line------------- ---- N F Number of pits--:-,------------Lining material-� _-Size: Diameter--3..........Depth--___.7_4 -------------- t . Cesspool: Distance from nearest well,----------------Distance from foundation--- ----------------Lining material--.------------------------_----------. ID Size: Diameter-----------------------=-------------Depth---.-------------------- -------------------------Liquid Capacity----------------------------gals. 14 Privy: Distance.from'nearest well--------------- --------------------------------Distance from nearest building-- --------------------------------------- El uilding_ ----_--._-------_----__----------.----.❑ 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 and. regulations:of the San Joaquin Local Health District. (Signed)............ �''�4�4--+- .--- ; ------ --ems-'r-----------:-- - ---------------------------- wner and/or Contractor) ;•; By: -- - --- -- --------=•-----------------------(Title) --- an ---:�-V- 4or---I---- -- - (Plot plan, showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). i f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------=-------- ---- --------------- ---- t DATE ' . �f ---- REVIEWED BY------------` T--------- DATE-----=------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------ ----,------ DATE------------------------------ ------------------------------ Alterations and/or recommendations*- ----:.- .n ---------C-� - -- ------ •--------- ------ �_ .4. ------------------------ ------ ----------------------- 71--V&96--_,d-- ------V, -' ------ YCX�(+�,� L44?. - f — �L�a e51� - ---_ - -- - - _---_ -_`- 6/e�y---.- �y.� - - _.----- -- - - +v-a.'tita-------- •--------•-•--------'-------------- .- FINAL INSPECTION BY:.--- - - --.- - - 1 .! - ------ -- Date- --- ------------------------------------ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street- 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California REVISED B-59 3M 3-•63 F.P.gp.