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FOROFFICE USE: „ - --------------------- 7f . .."_ ------- " APPLICATION"-FOR,SANITATION PERMIT Permit No. ;........_.�-_ -----------=--------------- --------- --------- (Complete in Duplicate] 3 This Permit Expires 1 Year From Date Issued Date Issued --------:..� -_G Application its 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 Ordina e No. 9. . ----- . -- -------------- ---'-,- ------ -------------------------------------------------------------------------_--------- JOB ADDRESS AND OATION.-. { I h � Phone ...Owner's Name----- ---------------------------------------------- Address-------=------------------------------- -- - ...... --------------------------------------------------------••-------------------• -------------------------------------------------- N 1 Contractor's Name--•------------ -------- ------------------------- --------------------------------------I---------------------. Phone------------_------•-------------- Installation will serve: Residence' 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-/----- Number of bedrooms " Number of baths _/__ Lot size ---------------------------- Water Supply: Publ c.system y Community system ❑ Private ❑ Depth to Water Table-5'p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'Z Hardpan ❑ Previous Application Made: (If yes,dateP?__S7.c2_ -1 No ❑ New Construction: Yes ❑ No ' FHA/VA: Yes ❑ No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS:— (No septic tank or cesspool permiffed if public sewer is available within 200 feet.] Ot'c ank:- Distance from nearest well-----------------Distance from foundation--.-----?' --------Material------------------------.----------..---------.... -"Li Liquid de th--.--------_-. Capacity -- i No. of compartments--- ----------------------5ize------•--------- ---------- 9 P . --------- p Y--------------�- --- Disposal Field: Distance from nearest well .-.Distance from foundation---/__4---"""---Distance to nearest lot line--/�_"-"- Number of lines!-----/.-.------" _ "__"" Length•of each line----3-4-1-------------.Width of trench....;2-40..........---------- i Type of filter material Depth of filter material---/S-.-_-----.Total length------------------- ---------..--_----- Seepage Pit: Distance to nearest well._)24! __Distance f m fundation--/-Q_--_---__.Distance to nearest lot lin - F Number of pits--i---/---- -------Lining material- .Size: Diameter-3-J! ---- .A ......... a Cesspool: Distance from nearest well-----------------Distance from foundation-----------. -_-.Lining material"_.-__.----------.------.-____-----. ❑ Size: Diameter--- -------------------------- -------Depth----------------------------------------------------Liquid CapacitY�------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------"-_---_---.----.-. ❑ Distance to nearest lot line-------------------------------------- t r' Remodeling and/or repairing (describe)--- --------------------------------- -,-- ------------••----------""----------------------------"-------------------------------------------------------- ----------------------•--- ------'----------------------------------------------------------------•--------------------------------------------------------------------------------------"----"-------------- ---- �. -------------------------------------- --•------------•------------•-----------------------------------------•-------------------------------•-------------------- -------------------------- 1 I herT, fa"laws, ify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinance altd rules and regulations of the San Joaquin Local Health District. (Signed) E -- ----- ------------ Owner and/or Contractor] B ------------(Title)- -------------- ---- . � e I (Plot plan, showing size of tat, locafion of system in relation wells, buildings, etc., can be placed on reverse side). F � � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ?.'r ---------------------------------------- DATE. / REVIEWEDBY-------------------------------- ------------ ------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------- - ---=----------------+---------- DATE-----_------------------------------------------�--------- AlterAlterations w------------------------------------�G ations and/or recommendafions:��/---- ---- "-.�---------- ---�"��--r`--`=��f----------`--�' =------- d :<---7�- �� -----------------------------------------------------•--•------- --------------------------------•----•---------- ------------------------------------------------------------------------------------------------------------------------------------------•--.---._----.--------------_..._-----•_----.-..--------'-------------------.---- "-".""------------------------'-----------.-..._--------------"--"-----------------------..-..."".- ----------------------'---------------------------.-------------------------'---------...---------..---'----------------- -------------------- r �/ FINAL INSPECTION BY:.. - -•---rANJOAQUIN ""'-�-�--- Date----- -=�------ ---•-------------------- LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 nEVI5E0 9-59 3M 3-'63 F.P.CO.