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FOR OFFICE USE: , ------------------------------------------ ------------- 'APPLICATIQ . N FOR SANITATION PERMITPermit No. G/ -- - - ------------------ ---- ---- ---------- (Complete in Duplicate) Date Issued ------------------------------------ This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____ _- /--�- 6 JL�- �g ------------------ ----------------------- - ------ --------------------------- Owner's Name------- - ----- --- Phony.-._------------------------------ - ------------------ - �t -•------------------------------------ Address ` - -- -- ••----- ---•••---•-------- Contractor's Name---------------- --------------------------- ------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Y Number of bedrooms 4 Number of baths __ Lot size _____�- _____...3r- �------------------- Water Supply: Public system Community system E] Private ❑ Depth to Water Table ' t. Character of soil to a depth of 3 feet::��nd Gravel ❑ Sandy Loam El Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date•?/�-_K/ A No ❑ New Construction: Yes 2—Ko ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Ta k: Distance from nearest well__ istance from foundalion___/__l�----___-Materiai f_-_____--_:____-_i _-____-_f No. of compartments-.- -------�--------Size----- 'aaUquid depth---------�----------Capacity--- ..... Disposal Field: Distance from nearest well ___.----------.-Distance from foundation----------------__Distance to nearest lot line________________. � Number of lines-------•---------------'----------Length of each line-•---------------------------.Width of trench--------------.------------ ------ i Type of filter material_______________---------Depth of filter material----------------------.Total length------------------------- ------ %A Seepage Pit: Distance to nearest well---_------------------Distance from foundation___________________Distance to nearest lot line-----_--_.____.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----.-------------•------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.------.-------Lining materia!__.----------------------________--_- ❑ Size: Diameter--------------------------------------Qepth------------------------------------------------ Liquid Capacity---------------------------gals. 'Privy: Distance from nearest Well ------------------------------------------------Distance from nearest building--------------------------- ❑ Distance to nearest lot line-------------------- --------------------------------------------------------------------------------------------------------------------- - Remodelin and/or repairing ---------- ---vY �- - j-.��-' - T �- ' ----------------------------------------- ' ------- `---------- - - --------------- ------•-----------��=----- �,,/ �ryr - -" - ---------------- ---------------- - ----------•- --- ---------- -- . , -=-•`��------------ ---=�=�=------------ ---• ---------1--'-�----`t�_��----- ------------- -- -/fix-------- -� � - I hereby certify that I have prepared this application and that the work will be done in accordance with San .1o�auin�County ordinances, f laws, nd rules and regulat• s of the San Joaquin Local Health District. 5i ned x --- ------- _______________Owner and/or Contractor) 9 ) --- - 1----------------------- -------------(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 F . APPLICATION ACCEPTED BY------- ---- "fY - !/�/- ' DATE .:= t REVIEWED BY------------------------------------------------- DATE------------------------------------------- •- - ------------ BUILDING PERMIT ISSUED DATE---------------------- -------------------------------- - ------------------- •---------------------------- Alterations and/or recommendations: _ ! '1 -- "'--- _4 ---- ----- �G , �f` .._._: �`` 'U:tie-s---.y -- ------------- �--r ----f--'--------I--- —.a--te- - ----- —f- � L.— --------------------------- -------------------- ------ ---� ----�---------- - --- FINALINSPECTION BY--------------------- --------------- Date.----------------------- ------ ------- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Harellon Ave. 340 West Oak Street 124-Sycamore Street 1205 West 4th Street Stockton,California Lodi,California W Manteca,California Tracy,California ES 9 REVIPED 8-59 3M 3-'463 F.P.CC.