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rVK Vrrlt.t uz)t: ----------------- ---------------------- --------------- / _ .------------------ _________.____._---.--------- APPLICATION FOR SANITATION PERMIT Permit No. ..4....(a_._-- ------- ----------------------------------------- ------ (Complete in Duplicatel /6 ` -------- - - --- 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 application is made in compliance with County Ordinance No. 549. v �' JOB ADDRESS A L CATI �_' --- --------------- •---- Owner's Na --- ! "''' -• `r''. L' rs r 2. �''�'"` k''-�alo,� r�t�Cl� -----. Phone------------------------------------ Address------- ---------------- ••---------------Address------- ---r �^�'._Sfc. t P F Contractor's Name - Phone ------.---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer r 9j Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms .;�Number of baths _rl- Lot size _________________________ "I------ ------ Water Supply: Public system ❑ Community system ❑ Private �epth 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 'ank: Distance from nearest well------ Distance from foundation__._J_�__._.___.Material______.._ No. of compartments----------71--�---------Size-- 7-X--'7_ -Y`S"-Liquid depth--------Ll---/----------.Capacity--- o Dispos Field: Distance from nearest well__._—SC?...__Distance from foundation__f_�__.A__.---.Distance to nearest lot line_S_/______... Number of lines-------------�----------_--_-- - Length of each line----_/-�fa- ------------.Width of trench------- --`----_-----_-- ---- Type of filter material_�r_�-CM�-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--------------------------------- 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---________________-__-_-- ❑ 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 lbws, and rules and regulations of the San Joaq 'n Local Health District. (Signed)-------- -------------------- rer,end/or Contractor) -----------------------------(Title)------------------- --------------- ------- ----- ---- ----- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ rc/' �:-t. -- -- ________ __________- DATE_- REVIEWEDBY------------------------------- -- ------------------------------------------__----------------------------------------..-- DATE--------------------- ------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------- ------------------------------------• DANE----------------------- ------------------ -------------- ----------- Alterations and/or recommendations:------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------------•------------------- -•--------------------------------------------------------------------------------------------------------------------------------------------- --------- ---------------------------------------------------------------------------------------------•-----------------------------------------------------. ----------- ------------------------------ ----------------- FINAL INSPECTION BY:..A' Date 10-------3... .1f _3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED 8-S9 31A 3-'63 F.P'CC.