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FOR OFFICE USE: -------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ I__._..__l./2...✓ --------------------------------------------------------- (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 mad in compliance with Co my mance No. 549. 2 S9-13v-a� 305' g S_ Qcvt'1 JOB ADDRESS A LOT ION ----------------------------------------------------- Owner's - --------•------------------- Owner's Name---- ----------v_-__�------ •---. ...- -------- ------------------------------------------- -- - Phone------------•--- ------------ -- _- - - ----�-- -•--------- .......... . Contractor's Name_.. ---..6._... ------- ----------------------------------------------------------- •-------- Phone----------------------------------- Installation will serve: Residence ` Apartm�ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_r--- Number of bedrooms __!Number of baths ---/___ Lot size ------- __fir......�_-.__.-_.----_---.--_--- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _ 0,oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel` Qandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No rr� 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.) 1 1-11 Septic Tank: Distance from nearest well Disfiance from founion.___ _ ._..Ma eri�l_____ ____ _______ __________. _L (� No. of compartments.... -----Liquid depth-----�--- Capacity.....?5-_ '__-- i vDistance from foundatio .-%1_5 _-_--.Distance to nearest lot line----- Disposal Field: Distance from nearest well--- __.______ V Number of lines-_-------/_ _-_.--.-_----Length of each line------ --------------Width of trench- .^'L_�._4--- -------- -Z' . Type of filter material_ ) 57-�--_-Depth of filter material----_-/5—t-._ _ --.Total length___ _____________________________ 10 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.-_-------_------ ❑ Number of pits------------------ Lining material-----------------------Size: Diameter-----------------------Depth-----------.--------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------._-.-_.-----__-------------_-. ❑ Size: Diameter----------------------- --------------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. S? Privy: Distance from nearest well-------------------------------------------------Distance from nearest buiiding-_.-------------------------------------- Distanceto nearest lot line------------------- --------------------------------------------------- -�J--- ;------------------------------------------------------------- W Remodelin and/or repairing (descri .e):----_ 2 ._,. ___ _ ._ ____. f�__!__ -- - c ___ _______________ C ---------- -�-lit.-r��a•�rL-- ----•='"'-`-�---�--•---- -��=�; ---�---- u --------------------------------------------------------= --------- ------- ------------------------------ ----------------------------- " ---------------------------------------•------------------•---------------------------------------------------•----------------------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, States laws, and rules and �regulations soof the San Joaquin Local Health District. Si ned rx / �-•�._ C car_ ��- 77- (Plot -¢----.---��'z---------------- --.----------- ----Owner and/or Contractor { g { 4 ----- -�- - { ) cry.-- --- Y (Title) 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----------------- ----- ------ - - ----- ------------------------------------- DA E. --------------------------- ----------------- P- r REVIEWED BY --------------- DA f'_ 1:- -t-A 5 BUILDING PERMIT ISSUED------------------------------------------------------------------------ DATE. ----------------------- ----------- -- Alterations and/or recommendations: --------•------------------------------------------------------------ ------------------------------ ---•---•-------•-•--------•------------------------------------------------------------------------------------------------------------•------------------------------------------------ ----------------•------------------- ------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------- -------------------------------------------------------------------- FINAL INSPECTION BY:.------ C ------- Date------- - ----------- - -- 'Z �.�'.. '---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.P.CO.