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-- -- -- - -- ---- ------- --------- -...----.----- APPLICATION FOR SANITATION PERMIT l // Permit No. ..--.....---... ------------------------------ (Complete in Duplicate) ------ -- --- - ------ ------- ---- -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. kee This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L.O—CATI N_.-..---VX.__ Owner's Name-----S--1�J.y---- - -- ---- - - ----- Phone -77- ---- --- -'..'---- l.......--------------`-- ------------`------------------- Address-------.._..----�tt1-t-- . eF� - ' Contractor's Name......... ...... ....... .... Phone ` Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms ..._... Number of baths _.X LOt size _._.. Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayk' Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------:........) No (V 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 Septic Tank: Distance from nearest well_..,p_v---.Dist frof� puna on_----LQ..-,--__.M terial..._/.�: -- -t ---. `' No. of compartments------ [ .F;.( > Liquid depth.._.�_'�........_J..-Capacity 1�.Q..._ Di s a al Field: Distance from nearest well_.�L2__...Distance from foundation.__.9..-.Q___.Distance to nearest lot line--s-op Number of lines....a.............. ��.....g. Length of each line.__..1.Q.Q.._ft_._.Width of trench..--. .��..___..___.. lee Type of filter material...t_ CQSctCDepth of filter material_____�_g_._.___.Total length------------�_e-i_SO v A Seepage Pit: Distance to nearest well......................Distance from foundation................_..Distance to nearest lot line._._.__.__.__.... C ❑ Number of pits._..___.-----___._.Lining material____.............__..Size: Diameter---------.-------------.Depth-------_..__.-___.___.__...__ t. Cesspool: Distance from nearest well.........._-----Distance from foundation....................Lining material-----------..._----_._:_._---_--__ ❑ Size: Diameter--------------------------------------Depth......................... -- ---.-Li.-Liquid Capacity 9 --------------------gals. Privy: Distance from nearest well. ...........................Distance from nearest building.....__....__....__._....------._..._..._. ❑ Distance to nearest lot line-------------------------------------------------------------------_....`-------------------------------...-.-------------------------_.. Remodeling and/or repairing )describe) ----- ------------- ..........................- -------------`----'------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County bin ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dist��rt c (Signed)._._ _..__ [.__. .._.. --_--- .- -_1:_r -(Owner and/or Contractor) W By:- --------.......-........ ---------_-------------------------------------------------------- .....-.._.(Title)------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------------------------- -- --- / DATE /- REVIEWED BY------------------------------------------------------------------------------------ DATE `Jb-��d �. BUILDING PERMIT ISSUED.----......-----------------------------.--...... ....... ........... DATE--------------------------_--------_------- Alterations and/or recommendations:---------------------'......------------------------------------------------------------------'-------------------------------------------------- --.....------------------------_------------------'-- - ------------- - - •--------------------------"----- ---`--------------------------------•------------.._.._.. .._. -- ----------- 'i-='� Date-----------=------ FINAL INSPECTION BY:. .............. - l`'� --- .. . .- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California EE 9 REVISED B-59 3M 3-'63 F.P.Ca.