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FOR OFFICE USE: -----_------_______'.V--.---,.�---..--.---..------ --- APPLICATION FOR SANITATION PERMIT Permit No. .. 6 -------- - ------ -- -------------------------- ---- - (Complete in Duplicated Date Issued __ 1�__�e/ / _� ..................------------------ ..._ ------ 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 made in compliance with County Ordinanc.A No. 549. ` '� JOB ADDRESS AN CATION '"'� --- ------ - ----- ----- -- ------------------ ---------- --•• -- - POIOwner's Name-- •� •-------�----------- Phone Address----------------- �� ___ ----------------- • - Contractor's Name -..... �..c ----------------------------- Phone-.-•--------•-•--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑' Trailer!, ourt ❑ Motel ❑ Other Number of living units: _- -.- Number of bedrooms -------- Number of bath s__.---_ size --------- --------------------- Water Supply: ' Public system ❑ Community system ❑ Private Depth to Water Table .3.7 ft. Character of soil toe depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] 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.) r Septic Tank: Distance from nearest well_�-�} Q._--___Distance from foundation_!/_Q_,._-.-.Material-.- ✓ 61914V Septic No. of compartments--__--__sZ-.___-_-_._Size__3X� �---___. Liquid depth-_-. 7 ---- ----------Capacity---Rd 0----. r 0.----_-.Distance to nearest lot line. a �--- Dis osal Field: Distance from nearest well.6l,�-_..._,Distance from foundation_._ Number of lines------_-_�__________ _ __ Length of each line---g-0_'.--------.-.Width of french........ Type of filter material__ f�D:r ._Depth of filter material____./9___...._Total length------------------------2-------------- tjA Seepage Pit: Distance to nearest well----------------------Distance from foundation---__I-'-_-----__.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----------------------- '- ---1� __ -_Liquid Capacity- ------------------'----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.-._----.---_----_----------.-.__-_-. ❑ Distance to nearest lot line----------------------------------------------------------------------- = ----------------- - ---------------- --------------------------- i I , Remodeling and/or repairing (describe): f---- -- -------------------------------------------#----- - A.. Y ---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- f t �' 1 _ . -------------------------------------------------------------•----------------------------------------------...-------------------------------------------------------------- -------------------------------- ----- --- --- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ` f ordinances, Stat laws,.and rules and regulations of the San Joaquin Local Health District. t `I {Signed] -- _'------- --------- f t ,±, (Owner and/or Contractor} By: ------------' (Title) . " - .t ---- ---=-------- --- (Plot plan, showing size of lot; location of system in relation,to wells buildings,.etc., can be placed on reverse side). r ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ------�1-: '--------------------------------- DATE--------------12 // t' -7-------------------- ., REVIEWED BY------------------------------------------- ------------------------------------------------------------------------------- DATE------------------- --------------------- BUILDING --- -----------BUILDING PERMIT ISSUED------------------------------------------ ------ --------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:------- --------- ---------------- ----------- ------------------------------------ ------------------------------------------------------------------------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------•-----------•- ------ -----------------------------------------I------------------------------------------------------------------- -------------------------I------------------------------- ----------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------------------------------------ ----------- /vs ' FINAL INSPECTION BY----------------------------------------- -v-. .------------ Date----------- t----------11 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetfon Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.CD.