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1-VK CUrl-K-t U�>t: J -- -- ----------------------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -• ------ - - ---- -------------------------------------------- (Complete in Duplicate) I `7 �•� -- ----------------- ThisThis permit Expires i 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. JOB ADDRESS AND LOCATION_ Owner's Name------b'-6 � n ,�1 '" ------------------------------------------ ---------•--------- ------------------ Phone------------------------------------ Address..--- 'I -�'. I ` Contractor's Name--- /L+-- ----- V� •------•------ Phone----•---••----------••----_ Installation will serve: Residence ZApartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: - ,I-- Number of bedrooms _ Number of baths _#;q��Iot size _- r- ----------------------------- ----•- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1;7___ 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)o 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____1 d,--_____-Material___d'0 -------._ _ �i No. of compartments--------- _�--------------Size_7__4:,�/U_ �1�-� q p --------Capacity---f y� -__ n _ _____ __ .Liquid de th-____�___--..._ Dispos Field: Distance from nearest well.... O__._Distance from foundation____f0..______-Distance to nearest lot line.___._.___ U Number of lines_____-_-�_-_____. ____ Length of each line______��___ � � rr p --is-----..Width otrench.-----�-�----- Type of filter material---,�rf�'�f�_____pe th of filter material....../.________Total length_____0�Q________________ ____ Seepage Pit: Distance to nearest well------------------_---Distance from foundation--------------------Distance to nearest lot line-----.________.._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------- Cesspool: Distance fi-om nearest well------------------Distance from foundation--------------------Lining material-__.__._..____._------__._______-____. 'S ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Disfance from nearest well---- _________________________________________Distance from nearest buildingG ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- I { 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, 5 to laws, and rules and regulations of t e San Joaquin Local Health District. (Signed)----- --- ----- ------- --------------------------------------------------------------- wner and/or Contractor) BY: s "' --- ........ ---------------------------------------------)Title)------- -- ------------------ -- - -------------- ---- ----- - - (Plot plan, showing size of lot, location of sys+em4n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEpBY_ � ------------------------------_-- -- --------------- DATE--?.-y7---------L�.-- --------------------------- REVIEWEDBY---- -----------------•---------------------------------------------------- ---------------------------•-------------------- DATE BUILDING PERMIT ISSUED---------------------------------- --------------------------—-------------•------------------------ DATE Alterations and/or recommendations:--------------------- ----------------------------------•--------------------------------•-------------------•--•-------------------------•- -------------------•-----------------------------_------- ------------ ---------------- ------------------------------------------------------------------------------------ -------------------------•--- -•-----------------------_---------------------------------------------------------------------------------------------- --------------------------- ------------------------------- - ----------- ----------------- --------------------------------------- --------------------------------------------•----------�------- ----------------------------- -------------- --------------- - FINAL INSPECTION BY:.-,4 .. Date---Q._.. _.3 b---403 -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8.59 3M 3-•63 F.P.CD.