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F R O FILE USE: •/ --------------- APPLICATION FOR SANITATION PERMIT Permit No. .. ............. ------------------------ -------------------,------- -------------------------- (Complete in Duplicate) Z _____________ This Permit Ex ires 1 Year From Date Issued Date Issued ___,_______...... -7 Application is hereby made to the San Joaquin Local Healfh 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 LO TION._,,3_-f-f-1 � l 4 I — `-- rk �� i a ----------------------------------`-----�-------------------- Owner's Name----------- r � �' a l-'D------------------------------------------------------- Phone.4bT' ..� - Address--------------------------------t_��_�..-. -------------------------------------------- ...... .-------------------------------- .. Contractor's Name ---------- ----------------------------- Installation will serve: Residence Ej-�'_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of loving units: -1----- tuber of bedrooms _TNumber of baths -_/___ Lot size 47_rf_Z-S-_ ----------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ 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.) Stic T k: Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------ .j No, of compartments------ -------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- DI A. Distance from nearest well AAAL----_Distance from foundati n_1Q__ __-__Distance to nearest lot line_____ r Number of lines------I____________________ _______Length of each line___. '_-_or---------Width of trench-.4��___.___.__�__._ r A Type of filter material` ___Depth of filter material------/!!....Total length_________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________Distance to nearest lot line--------......... ❑ Number of pits----------------------Lining material----------------------.Size: Diameter--._-------------------Depth--.------------------------------ J Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_...____.__._________________________ ❑ Size: Diameter--------------------------- ----------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------- ------------------------------------Distance from nearest building-----------------------------------------. fT1 ❑ Distance to nearest lot line---------r------------------------------------------------------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe)'----------; W o -/� E N__Q1 - -- - -/ Vn- -------------------- +------------- --------------•--.------------•--•--------•---------- ------------------------- -------------------------------------- ------ ------------------------------------------------------------------------ �r 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 r�ul/es and regulations of the San Joaquin Local Health District. Signed)-- f-`x-42---- ----�=7--------- r - --------------- Contractor) . BY•------------------------------------------------------------------------------------------ --- -------- -------- ----------------(Tale)---------------------- ------------ ---- --- -------------- (Plot plan, showing size of lot, location of system in relation t wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY----C,T � - ------------- ------ ---------------------------------------- DATE----4'z ' --- ----------------------------- REVIEWED BY-------- ----------------- -------- ------------------------------ DATE----------------------• ------- -- --- ----------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommend at ions:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•------------------- FINAL INSPECTION BY:.__ _._ __ ---------------- 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 ES 9 REVISED B-59 3M 3-'63 F.P.CC.