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FOR.OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ./Z --------------------------------------------------------- �._..._..... -- ------------------------------------------------------ (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. JOB ADDRESS AND LOCATION---/Y- :--.- 3s_AA- 1 - a � "r� .1.-- :_ _<_- - (/ - Owner's Name = r-. ��- -tT--------------------------------------------------------------------------- Phone Address-----e..xe...- ! ------- .:: t ------------------------------•-••-----------•--------------------- ---------------------------------...---- Contractor's Name--------- � ?-z�.-.- ..--. j � c ° ----------------------------------------- Phone----------.------------------------ Installation will serve: Residence M Apart int House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.I--- Number of bedrooms _-Dumber of baths ---I--- Lot size -------------7-----.----------------------------------- Water Supply: Public system ❑ Community system ❑ Private k Depth to Water Table _- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ 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 available within 200 feet.) Septic,Tan Distance from nearest well-----------------Distance from foundation--------------------Material-----..--------.._._----------------..----.-----. W No. of compartments------------- ----------f Size--------------------------------Liquid dep. h--------- ---------Capacity-•---------•--------- S Di s o al Field: Distance from nearest well---/Sp--_Distance from foundation...... V....._.Distance to nearest lot line_------------ {� Number of lines--------G------------------------Length of each line_ ', _- - -...Width of trench-----.... - -------------- Type of filter material.--5-7 __Depth of filter material------/-g-_.----_..Total length----/-_X_C----.--___-_____.------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-__--__---_--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--.--------------------Depth_----.-------------------------011 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.----..-.--..----._----_.--._----_. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity----------------------------gals. -.W - Privy-. Distance from nearest well-------------------------------------------------Distance from nearest building--.-.----.---.-_--.-_---._._-.---..--_----` F1 Distance to nearest lot line------------------------------------ -------- --------------------------------------- ---------------------------- --- Z Remodelingand/or repairing (describe);------ --__----------------------- ------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - - ---- i! h I hereby cey rf y that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- d ------------------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------- -----------------------------(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---------------------------------------------------------------------------- DATE ----------------------------I------------------------- REVIEWED BY------------------------------------------------------------------------------------------------- !tr . DATE:::::.Jt BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE-------- - -------- � -- ----- --------------- Alterations ---------- Alterations and/or recommendations-------------------------------------- ---------------------------------------------------------•- -----------------------------------------------------•------- ---------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------•-----------•----------•--------------------•----------------------------- -----•-- i 7 .� FINAI. INSPECTION BY:- - ------ �------ - --- - ------------• - - Date-------------------=�---------•-- ----------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISES) 9-S9 3M 3-•63 F.P.CO.