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FOR OFFICE USE: P _ ______________________________________ -----------------_---__---____-______-__________-_______ APPLICATION FOR' SANITATION PERMIT Permit No. __ 7,3� ----- ------------ ---- --------- (Complete in Duplicate) , '- ----------.--- This Permit Expires 1 Year From Date Issued Da+e Issued ____`irf-. Application is hereby made to the Sart Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in-complianlce with County Ordinance No. 549. r JOB ADDRESS AND LOCATION-_ _�Z_: �J,�Y_ - � ----- Owner's Nam1�Q' ;... `�`��11 / ---'----------- Phone - Address----- �- e.Z- " �� ---------- Contractor s Name ` !" __ : ---------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l Numbei of living units: .-_---- Number of bedrooms_-_ Number of, baths ,__ _ Lot size - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table IA._ 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____________________J No Cr New Construction: Yes Er—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_•,5-0-__------Distance from ifoundation_14__f__________Material -_-___ 011.0 ------------ N6. of compartments- � --------Capacity_--- -/-__ ize___ � X --Liquid dpth___ Disposal Field: Distance from nearest well...-1_'0 _ -a� Distance from foundation_ _ ______________Distance to nearest lot line. __________ Number of lines-----Z __________________Length of each IineB______ I � - - - -.Width of trench.-Z ------*(------------------- Type of filter.material__1.o�C----------Depth of filter materlal__J$'_________---Total length_ -gJ-------------------------- Seepage.Pit: Distance to nearest well-___________________Distance from foundation..............._._..Distance to nearest lot line----------------- , V ❑ Number of .pits ------Lining material---------- -----------Size: 'Diameter.----------------------- 2 i A Cesspool: Distance from nearest well________________Distance from foundation---------------------Lining mafe'rial-----------------__-___-_____________- ❑ Size: Diameter -----------------------------Depth_------ ------------------:-------------------------Liquid Capacity----------------------------gals. k Privy: nearest buildin -- - T9 ----------- -`- =-"- ' ❑ Distance:from .nearest well__ ________________________ �pistance from Distanceto nearest lot line----------------------------------------------------------------------------•-•----------------------------- ---------------------------------- Remodeling and/.or repairing (describe)---------------------------------'_----_-----__--•------------ z � _ ._ ; -- ------ -------•--------------------------- i • --•------------------- t _________________ __________F______________________.____,___________-___________-__________________________________ ________________-_-_______________-_________________________________.___________________________- 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 +he San.Joaquin Local Health District. C�& (Signed)---.------ --- -----L--------- _-- ------ -4--rte--- .... and/or Cont actor By: - ---- (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 J APPLICATION ACCEPTED BY------ ----------- 1�1 r� DATE----------- --- -(a`4 REVIEWED BY i ' - -- ---------- DATE-------------------- BUILDING PERMIT ISSUED �--------- - ---------- -------------=-------------------------------- T�E---- ------ -----------------------------=----=--=------ Alterations and/or recommendations__________ __ — -�`tt - ---------------------------------� - P --- � .-. � - , -------------- -------- ----- --------------=------ -------- FINAL INSPECTION BY:-----✓ ----------------------------------------------- ---------- "-------- ------------ -- Date------------ 7._ k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hmeltort Ave. 4 300 West Oak Street 124 Sycamore Street 205 West 9th Street II Stockton,California Lodi,California Manteca,California Tracy,California ES 9 DEVISED 8-59 3M 3-•63 F.P.Q0.