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F07 OFFICE USE: i _____ -_ _. APPLICATION FOR SANITATION PERMIT Permit No. .... - ------------------------•------------------------------ (Complete in Duplicate) y��5 lv 5 ................ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION--------- s h ' _. r�--------� 'e--------------------------------------------------------------•- ------------ (/7 cz �` ;��_�?'ts-`-.f7` ---------------------------------------------------------------------------- Phone..._..-------------- Owner s Name-------------------�- -�----------- � --------------------------------- Address_------------------- 1 r------ G� ti f 1 ° `� -.��---�_e-------------- Contractor's Name--------------------_�f'� Phone---... -41--��----� ----------%----- 5 -------------------------------------------------------------------- `� Installation will serve. Residence R- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.t--- Number of bedrooms J---- Number of baths _-/____ Lot size ______ _S�X____ �_-�_________________________ Water Supply: Public system & Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3--Hardpan ❑ Previous Application Made: {1f yes,date--------------------) No R2-- New Construction: Yes ❑ No ®- FHA/VA: Yes ❑ No 94- 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-____--____----_Distance from foundation___________________Material------------------------------------------------- 1:1 __-_---__---_--_____.-._-_____------ -_--_. ❑ No. of compartments------------- ------ ----=Size--------------------------------Liquid depth-------------------------.Capacity---------------i------ Disposal Field: Distance from nearest well._.Q�a�C .Distance from foundation---La____.....Distance to nearest lot line--- '____--- (a— Number of lines-------- _______________________Length of each line__________ e_ ...........Width of trench-------Z---f_ Type of filter material-_- k_-Depth of filter material____1 -------- �`_..____Total length---------- _ '_ ______________ -- Seepage Pit: Distance to nearest well_ a_ .S%-_-__Distance from foundation____—a_____..-_.Distancfe to nearest lot line_S- ------- e-- Number of pits--------1------------Lining material-----/+`�_'__Size: Diameter-------3 .__.- ---Depth-------z-s-`_--•-------------- w Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material---------------------------- Size. Diameter-------------------------------------=De th---------------------------------------------------_Liquid Capacity ` als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- F-1 .____-__-_--_______--__---_- __.._.[❑ Distance to nearest lot line------ ----------------------------------------------------••----•-•----•------------------------------------------------------------------- Remodeling ---•------------------- ---------Remodeling and/or repairing (describe):----------------------------------- ----------------------------------.--------------------------------------------------------•--------------------•--- ----------------------------------------•-----------------------•------------------•-----------------------------•---------------------------------- ------------------------------------------------------------- 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. _ 1 (Signed)-------- ---- --- --- ---~- ---- ------------------- ---------------------------------------------(Owner and/or Contractor) 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 APPLICATION ACCEPTED BY - —-' --------------------------- DATE ��----`--- ------- REVIEWEDBY--------------------------------------------------------------- ---- ------------------- ----•- DATE__._ BUILDINGPERMIT ISSUED--------------------------------------- --------------- --------I--------- DATE--------------------------I----------------------- --------- Alterations and or re�ommenda�t o_ns:__.____ _ >. - --- --- -------------- --- �----..-.., �------------ 1 r C'---------------------------------------------------- •------ ---------------- ------------------------- ----------------------------------------------------------------------------------•------- ------------•---------------------------------------------------- ------- FINAL INSPECTION BY:- ----rSAN --- ` - Date--- -/ - -- ------------------------------ -------------- It JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. t Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 6-59 3M 3-'63 F.P.CD.