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FOR OFFICE USE. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .__ ------------------------------ (Complete in Duplicate) Date Issued ----64.1�146 I/ Application__ _________ This Permit Expires 1 Year From Date Issued .r /� cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap.plicat,ion,is_made-incompliance with County Ordinance No. 549. p'D �L / t� -------A --+-g JOB A RESS AND`LOCATION---- -•-------------- ------ ------------�✓�_�_._.,--� -� -------- - -- ��`�'"�----------------....------------ AA ` Owner's Name----------f ----'x!------- - �� =t - •----•------------- ------------------ -- ------------ ---------------------- Phon Address------------------------- - 1�-Z----a ...J- ------------------r -----------------------------------------------------------------------••--•-----------------•-------------- Contractor's Name--------------"' _'- '-wAnfn---------=---------. ----------------------------------------- --------------- Phone------•-------------------•-------- Installation will serve: Residence )H Apartment!House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: __!____ Number of bedrooms'__' Number of baths 1_._ Lot size ____ -`------------------------------------ Water Supply: Public'system ❑ Community system [I 'Private JE] Depth to Water Table'7r__ ft. Character of soil to a depth of 3 feet: Sand 0- Gravel ❑- Sandy Loam ❑ Clay-Loam E] Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (If yes,date ------------------- No El New Construction: Yes. No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -w Septic Tank: Distance from nearest well--________--- Distance from foundation-----__ii�_____:--- Material____________________ ____________.________.iw [ No. of compartments-_--i-11---------------Size--------------------------------Liquid',depth-.� `--------- --Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation___--_-._-__________Distance to nearesttlot line---------------- ❑ Number of lines--------------------------- ---- Length of each line------------------------------Width of trench-----';----,--.------------------ 0 Type of filter material__________ ___________i_Depth of filter material-----------------------Total length,------------- _-:_____________--____-- ' �tJ t r Seepage Pit: Distance to nearest well_4_______._ ___Distance from foundation___..©___-___-._.Distance to nearest lot line_ ' __-� ! Number of pits---- ,�___._________Lining ;material_____.__-Size: Diameter___ __.._.__Depth....2'.rS`!;________________ Cesspool: Distance from nearest well __Distance from foundation-----_.------------Lining ritiateria!------------------------------ ________ ❑ Size: Diameter------------------------------------- Depth-------------------- ---------------------- ------Liquid Capacity--------- ------------------gals..l,r� Priv Distance from nearest well----------______----------------------------.-.--Distance from nearest building-------------------------- [� Distance to nearest lot line-------------------------------------------------------------------------------------- ------------------------------------------------------ Remode.ling and/or repairing (describe):----------------------------------------------------------------------------------------------•------------------------------------------------------ ---------------------------------------- ------------------------------------------------------------------ ----------------------------------------- ------------------------------------••------------------------ i e I 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 rules and regulatio f the ,Joaquin Local Health District. �1- .----------------- ------------------------------------(Owner and/or Contractor) (Signed)----- ' r Title By:----------------------------------------------------------------------------------------------- ----------------( � )-------------- ------------- ------------- - -- ---.----- --_.. (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-------- lop ----- ---- ------------------ DATE__r!`/��.--------------- ------------------ ------------------ REVIEWEDBY------ ---------------------------------- - - --------------------------------- ---------------------------------------------- DATE--------------------- BUILDINGPERMIT ISSUED---------------------------------- --------------------------k-------------------------------------- DATE-------------------------- --------------------------------- Alterationsand/or recommendations-------------------- --------- ------------------ ----•---------------------------------------------------------------------------------- ----------- ----------------------------------- ----------------------------------------- ------------------------------------------------------- ------------------------------------ ----------------------------- 1 FINAL INSPECTION BY:__14�4 * x Date l-��`----D-� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED e•S9 31A 3-'63 F.P.CD.