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VOK UVVILI: UJt: - -- _ APPKCATION FOR SANITATION PERMh" Permit No. -------------------..................................... (Complete in Duplicate) _... .._......____ This Permit Expires 1 Year From Date Issued Date Issued ..... .-101 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 CATION-- KI .CjClZi�iti----�. ----------- ------------------------------------------------.._. Owner's Name,--�-- -- '---- - - '- -- - - -- - I ------------------------- ----------------- Phone ---------------------------------- Address---------x`7......1 �x2`1S- --- ------- -- - - --- Contractor's Name-- / - - - --- - -- -- = -.. .. -----------------------------. Phone----------------------------- Installation will serve: Residence [K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ... Number of bedrooms _3--- Number baths -0'-Lot sae ....._7Z-----.�-.-a ........... ...... Water Supply: Public system E] Community system ❑ Dpth to Water Table ._._-. ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Clay ❑ Adobe E] 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.) Se tic ank: Distance from nearest well----- Distance from foundation Material-------.�ltf0___.._------._.---- r / Pq No. of compartments-----,9.Z.............Size�.�-.��-'._.j'��quid depth__.-_ .......... .Capacity.._Za�o�4�C Disp>o Field: Distance from nearest well...-5 ....__Distance from foundation----/IL__...Disfance to nearest lot lines._._. .-.. Number of lines ---- -Length of each line...../.OU........_-Width of french.......�'�.,......�_---_..-.. Type of filter material-_ __ Depth of filter material-_./. _ .._.Total length._...._ -'a4-.._-------------- e e Seep/ a Pit: Distance to nearest well__._L..4_C.___Distance from foundation.....-.P- -.-.Distance to nearest lot line_5_'.-__.... '�� Number of pits...... ...............Lining material---------- _____Size: Diameter- ------.----__._Depth.... Cesspool: Distance from nearest well__------_. ---Distance from foundation__.. -----------. Lining material___._.___ ------------------- j ❑ Size: Diameter- -------- - - ---------------- Depth----- ---- ----- -------------------- Liquid Capacity...-------------------.. gals. Privy: Distance from nearest well__-_---_._.__. -------------- ---------_Distance from nearest building-----_____.________._..-.. ❑ Distance to nearest lot line------------------------------------------- ---`----------'--- ------------..... ...- _ --------- q. Remodeling and/or repairing (describe):---- -----------------------`-----._--_ ----' Q ------------------- --------------------------------------------------------------------------- ------------------------------- - - --------------------------- - --- ---------------------------------------------------------- --------------------------------------- ------ -----------------...........- -- - 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. Signed _----------------- -- --------..--._. or Contractor ( 9 ) - - - - - - ( ) ------- - ------- - - 4__..._ 1 ------- ----(Title)------ _ ....... - - - (Plot plan, showing size of lot, location of system in relation to Jells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ` ---- ----------------------------------- DATE..--V'.2 ------------------ REVIEWED ---------- -------.REVIEWED BY----------------- ---- ---------------------------------------------------------- ---- DATE-- .--_-------------------------. BUILDINGPERMIT ISSUED----------------------------------------------------------------------_----------'--------- DATE--------------------------------------------------- Alterations and/or recommendations: ------------------------------ ------------------- ----------- --------- . ------------------------------------------------------------------------------------------------------------------ ........----------------------- ass - ------- --- ---------- --- -- ---------------------------------------------------------- .. tes FINAL INSPECTION BY:- ------. ?1:i 2 G a L i---------- - - Date.. -----------------/--------- - ------ ---- -------------- less ------------tr SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California Is. ES 9 REVISED 6-59 3M 3-'63 RP.CD.