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FOR OFFICE USE: ............. I -------.-----.----- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ._..l_s��..3rE'... ------- --- - ------- -- -- - . ---- ---- (Complete in Duplicate) -----------_ This Permit Expires 1 Year From Date Issued Date Issued Z Application is hereby made to the San Joaquin Local Health District for a permit to consstr Ct and install the work erein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION--*---�— f ,----- � -- . ----------------------------------------------- ----- --------- � Owner's Name.------t4 - ---. ...•-------••------------------•--------- . -- •--------•--------•------------ Phone.------------ ---------------------- Address !' .... ------------------------------ -------------------------------- Contractor's -------------------------------- Contractor's Name-- ------/7_.-• �2 '------•----------------- - •------------------ Phone-� ---_-------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�.___ Number of bedrooms Number of baths ;a--- Lot size .._. $-_....�ice�'_ ...............__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table /,-)_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe/6 Hardpan ❑ Previous Application Made: (If yes,date -----..) No New Construction: YeAs No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_._____-.Distance from foundation------/ --------.Ma�rial._......_ _`._ems___....__.. No. of compartments___----_%_�'_._--..-----Size_ X-,!5._?t---.f---------Liquid depth....X_;;---------------_Capacitye.VC_54_ '11A Disposal Field: Distance from nearest well..__2-6__0y__Distance from foundation.___ld---------Distance to nearest lot Iine.___,5.......... Number of lines-------.__-._I -J_ :-_-Length"bf each line------- ~._-_...Width of trench--------- --....______--- Type of filter materials,_ _ Depth of filter material---____1k_.'__._Total length__.__.._..__._..Zd.G-_'........ / b � _ Seepage Pit: Distance to nearest well_......__.__.__.__Distance from foundation....................Distance to nearest lot lme__.-..-.--.._._. ❑ Number of pits------ ---------- _.-Lining material__. _._: .. ....... .Size: Diameter.................. ....Depth___._...____..._._-_.....__ Cesspool: Distance from nearest well--- ------ ------Distance from foundation._.................Lining material__.._._--_----------------- ...._ ❑ Size: Diameter----------------------------- --------Depth------------ ---------------------------------------Liquid Capacity---- ----------------------gals. < (p Privy: Distance from nearest well---------------------------------.-------........Distance from nearest building------_--------------------------------._. P ❑ Distance to nearest lot line-- ---------------------------- -------------------------------------•---------------------------------•--------------------------------- Remodeling and/or repairing (describe):...-------- ,! .- -t ------- ---------------------------------------- ---------- 9- --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------ ------------------------------- ---------------------------------------------------------------------------------•-------------- •--------- -- -- --------------------------------- 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) �`- ------ ------ -------- ---- ------------- ------------------------ --- Owner and/or Contractor) r (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ---------------------- ------ --- - --- ---- ------- ------------- ------------------- DATE..---------------------- -------------•------------------- REVIEWEDBY - ------ ------------------- ---------------------------- - - - -- - - --- --- --------------------------. DATE---------------------------------------------------- --- BUILDINGPERMIT ISSUED------------------------------------------ --------------------•---------------- ------------------ DATE------------------------------------------------------ ------ Alterationsand/or recommendations:------------------- ---------------...-...--------------------------------------------•-------------•----•---.....-------------------------•------- "' --------------- -------- ----- - -----------------------------•----------------•--------•--•- ------------•-•------•---------- ------------- -----•------•-•-----•-------•---•-----...-------------------------•---•---... ----------------------- ---------- ---------------------------------------------•--------------------•----------....------•---.....---------------------------•-------......---------------•-----•------------------- ---•---------- -- --- --- -------------- ---------------- --------••---------•-------•--------------------•---------------•- -- -----------------...-----------------------------------------•------------ ---- ---- - - --------------------------------------------------- -- --- - ----------------------- ------- ,i —� FINAL INSPECTION BY:. -- -- J Date 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 ES 9 REVISED B-59 3M 3-'63 F.P.CD.