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FOR OFFICE USE: j --------------------------------------------------------- f I APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ---- ---------------- a in Duplicate) / . (Complete .. `Date Issued ------------------------------------- - -------- [ P P Date Issued This Permit Expires 1 Year From _ s - Application is 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 ith County Ordinance No. 549. 1vt JOB ADDRESS AND LOCATION_ -- -� .c>-_�_7. q ------------------- / 1 Owner's Name //--•---------- -- ' =-/ _ 1 - �r7 Phone Address ..�.7 _j�1_ a..�_ _ - '-� 'r'�� r --------••------------------- Contractor's Name---------------- ----r---- ,�/J -- f -- r•"'�.� ._ Phone.... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer ourt [] Motel ❑ Other ❑ Number of living units: -_9_-- Number of bedrooms ___ __ Number of baths----- Lot size ---- �_____________________________________________ Water Supply: Public system ❑ Community system ❑ Private ' Depth to Water Table Aatt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--..-------7--------) No New Construction: Yep,ft-,, No ❑ PHA/VA: Yes ❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: t G � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation---------------------Material___.-____._____.__._.__________._.._._____..___. � 7�2 f- No. of compartments------- ---- -------------Size--------------- Liquid de th--._----------------------Capacity Disposal Field: Distance from nearest well..,_5'-___Distance from foundation-----Lt9--------Distance to nearest lot line-_L6-_____-_ ❑ Number of lines-=-3----------- --- ------Length of each line-2-Q_-"6 o.`"60Width of trench---- -_S�-/-r__-_-_-__------ Type of filter material _ Depth of.filter material---_-.1-9-___...__Total length-_______� j _______. ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------.-------------Distance to nearest lot line--- ----------- f ❑ Number of pits._-------------------Lining material------------------------Size: Diameter------.-.--------._._..Depth--------------------------------- k Cesspool: Distance from neiarest well-----------.-----Distance from foundation--------------------Lining material____________________________________. r ❑ Size: Diame#er Depth ----------------- :_------- -------Liquid Capacity _..gals. Privy. Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ -- ------- Distance to neatest lot .line . -- -7 =p ` ------------ Remodeling and/pr repairing (describe):_ �" --' -- --!!!\,-: m c � �.r-fes 4._ -•N` � -'�P ��t�� Z' C. tf a ��cc� t-�I�C G E 11 ------------------------------------------------_ . E /p 4E 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.- >ar (Signed) `' ------------` ------ --=--- - (Owner and/or Contractor) r I3y: l� ? v ' _�_ .�7_G�Q-1=-a ----------= (Title) (Plot plan, showit'ig size of,lot,.location of system in relation to.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------ ------------------------------------------------------- DATE-----:------- -----= REVIEWED BY-'----. --------------------------------------------------- -- -------------- R DATE ✓ ------= �7 .--------•------ BUILDING PERMIT ISSUED. ----------------------- ---- -------.------------------------------------- DATE---- ------------------------- Alter ns and/or rcommendations -- - ----------------- ., r ------------- 1 -------•-- C_;...__ �x - --------------------- •------ . ...------•--- ---------------------------- :. r ----• FINAL INSPECTION BY: ---- ------- ---------------- ---------------------- Date--------------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.koseltan Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CD. ; _� d