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FOR OFFICE USE: ------------ ---- ------------......................__-----..-_-._--.____._..__--__. APPLICATION FORS`SANITATION PERMIT Permit No. --------- ---- :----------- -------------- f (Colnpleh in.11)4 catel -- -----.--- This Permit Expires 1 Year From Date Issued Date Issued ��3 -apo 21 Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work herein described. This application is made.in compliance with County Ordinance No. 549. E r JOB ADDRESS AND LOCATION--✓® -- --- +--- } Owner's Name L/ '�-� �-`�------ � I � Phone AddressA :. ----------------------------------------------------------- •--------------- Contractor's Nam+ _ ------ -------------------------------------- ------ Phone-----•-•----•---------------------- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms 2--- Number of baths .1_____ Lot sizeg ---------------------------- Water Supply: Public:System ❑ Community system ❑ Private �bepth to Water Table `Z- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes El—K-o ❑ FHA/VA: Yes ❑ No ❑`— TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance-from nearest welL_,�-.r....Distance from foundation_!L7-.-------._Material---/L - - ----------- ------------------ 0� No. of compartments---2-------------------Size---3--l-c57xI------Liquid depth____- ._-- ----------_--- Capacity----�----coo : --- -� Disposal f=ield: Distance from nearesf well-_5_U--------Distance from foundation----lb_`-------Distance to nearest lot line_ /.__... 14� Number of lines----:�------------------ -------Length of each line._7_s5.,----i-----�`-_.__---Width of..trench-.v�_fr_�'_____.------------- ' Type.of filter mat erial::_?U_G_ -----Depth of filter material_:/:Q'--------------Total - length-----f, 0�-- - ---------•--------- Seepage Pit: Distance to nearest well-.------- from foundation------..----...-_--.Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material------------------------Size: Diameter-----------------_- ----Dept h---------.----------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation....-----------------Lining material------------------------------------- ❑ Size: Diameter------------------ --------------------Deth--------------------------- - - - ----------------Liquid- Capacify-.Y- --------------------------gals. 3 Privy.' Distance from nearest well-----------------------------------------------------Distance from nearest building-----------------------,---------- ❑ Distance to nearest lot line-------------------------- --- -- w ------------------ deling and/or repairing (describe):-----__ Remo ---------__ .. ------------------•---------------•----------•-------- . t. i ------------------- ----------------------------------------------------------------- --------•-------------------------------------------------------••-----------•----------------------------------- ------------------------------------- I hereby certify that I have prepared this application and•that the work will be done in accordance with San Joaquin County ordinances, State aws; and rul and regulations of the San Jo quin Local Health District. (Signed)- __ ; -•-- ------ - -----------------� --- ------- ------- -------- f-------------------------------------------------(Owner and/or Contractor) `-�C�� Y -----------------------••-----------------------(Title)------------- ------ (Plot plan, showing size of lot, location of system in relation to'wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------- / - - - - - - ------------------------ ----- DATE-----I ��---(�-- --- --------------------- I REVIEWEDBY------------ -----------=•------ ------------------------ ------------------------------------------------------------ DATE BUILDING ------- ----------------•--------------------------- ' BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ---------- DATE------------------------------------------------- Alterations and/or recommendations:-- -----------=----------- - - ----------- -----------------------------------•-----------•=--•------------•------=---•- ---------------------------------- ------------------------ -----------------------------•--- --------------= ------------------------------------------------------------------------------------------------------------------- ----_1------------- I FINAL INSPECTION BY � ---- Date .. -------- - - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.Cn.