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t'UK UN-11-C 11-C Uac: ------------------------------------------.------'- APRICATION FOR SANITATION PERMW Permit No. .-._.._......__....- ------------- (Complete in Duplicate) �� _ This Permit Expires 1 Year From Date Issued Date Issued ._f S-. ? 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 L ". Ordiinance No. 549. pJOB ADDRESS ANDOCATIOtO: .................. -------- Owner's Name------- -- ------ ----- Phone---......-----------......------ L -------- - - - - - - Phone .....................- ----- . -,-Contractor's Name---------- • --° ........ Installation will serve: Residence [Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ LNumber of living units: .1---- Number of bedrooms -3-. Number of baths y... Lot size ----- t :............................ Water Supply: Public system ❑ Community system ❑ Private [� Depth to Water Table -------- ft. L Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ErAdobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------- ------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_S6----.-Distance from 0oundation--.1o_'....----Material-----C--/yt.�--------------------------- No. of compartments__---..y..-.-_.._Size.0WiCXj-X-S-.-.-Liquid depth........44!.__-------Capacity..le?4dQg.e--AZ_ Disposal Field: Distance from nearest well- 417V-----Distance from foundation...../0........Distance to nearest lo,line.5!... ...... L Number of lines._.._.......-11.-._----_-...Length of each line-....--V,&_.=a Vidth of trench -.:?c:..--.._.. ._----.---- Type of filter material---_—V__i -_._Depth of filter material.._j_R."__---..-Total length..-..PQ.Q:�..................._. Seep Pit: Distance to nearest well------LQO. -----Distance fr�mYfoundation....L.A-.-...-..Distance to nearest lot line$......-.... Mrn Number of pits....._.?---.......Lining material--- ---------Size: Diameter------3.1........Depth.....9_2------------------ .. Cesspool: Distance from nearest well....-..-.--_.-..Distance from foundation......-_---------..Lining material---_----_...._.-_-- .-_.._.. L ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------.Liquid Capacity--------------------- -gals. Privy: Distance from nearest well---------------------------------------__------Distance from nearest building........-...-..-.-------.-..-.---.--.--.-. ❑ Distance to nearest lot line......... - ---------------------- ...............------------------------`--------- ------------------------------ LRemodeling and/or repairing (describe):- - -- --------------------------------'---------------------------- ----- --------------------- ----- -----------'-- -----------------------............-•--.....------------..................--------'---------_--------------------------'----------------------------------------------------------------------------------------- --- - - - - --------------------------- ------------ ------- --- ------------...----------------------- -------- - -------- ------------------------------------------ --------- - ------------------------- - - ------------------- ---- •------------------ -- - - - - L 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 regulations of the San Joaquin Local Health District. L (Signed):--------------------------- ------- - -- ---------- ----- '--------------------------------------(Owner and/or Contractor) 1 (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). IL FOR DEPARTMENT USE ONLY �/ LAPPLICATION ACCEPTED BY- . . - ---.....- -....................-------'--------- DATE---- __r'- -----1- r------------------------ REVIEWEDBY----- _------------- ------------------------------------------------------ . .----------------"------'-'----------.- DATE---......................'-............................. BUILDINGPERMIT ISSUED----------------------------------'-------------------------- -----------_-_----_- DATE-------------------------------- -••--•...... L Alterations and/or recommendations:-_------------------------------___----------......--------------------------------------------------------_-_------------------------- --------......_----------__---......--......-----............ ...----- --------'..... -..................................................----------------_------------------------- L - - ----------------------- - - - ---------------------------- ----- ------------.....-------. ------------------------------- ' IFINAL INSPECTION BYY z:..G c_ --- --------- Date" G -............ - ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy,California LES 9 REVISED 6 59 3M 3-'63 F.pC