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!1 FOR OFFICE USE: r, �F . F------------------------------------------------ / 7 --------------- APPLICATION FOR SANITATION PERMIT Permit No. !1 (Complete in Duplicate) 7 ` - This Permit Expires 1 Year From Date_Issued Date Issued .-_C- 6...-.1�- ;Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. ilThls application is made in compliance with County Ordinance No. 54?. JOB ADDRESS AND CATIOt ✓y4---------- Owner's Nam - ---------- ------------ Phone---'--7_ - --•---- r -!Address cz2 �a -- ---------- - ------- - �. .. ��Contractor`s Name----- - - ---- -- --------- -- -•-- -- ----- ----------------------------------------- Phone-1.144"' l�Installation will serve: Residence ❑ Apartment House-Commercial ❑ Trailer+Court ❑ Motel ❑ Other ❑ ,[/ i s Number of living units: f Number of bedrooms __ _ Number of baths _-" _ Lot size .S-_.- Z�w------------------ €.Water Supply: Public systems Community system ❑ Private ❑ Depth to Water Table/40_ ff. Character of soil to a depth of 3 feet: Sand . Gravel ElSandy'Loam ❑, ,Clay Loam ❑ Clay ❑ Adobe C] Hardpan E] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No [I I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 fee#.) Material_4 � ^ Septic Tank: Distar ce from nearest:well-lam-Distance frpm fo undat�!_�� +� No. of compartments---�------------------Sizel eA.�_. 5_Liquid depth --_ --- -Ca acit f24 4a_ _ Disposal Field: Distance from ny ast well_Iw!' Distance from foundaf�-°�n __� ,...__Distance #o nearest lot line- ` Number of lines_ __ _______ Length of each line _Q___ Width of trench- _- Type of filter material%5 C_��- Depth of.filter material--,/ --------------Total length------- Seepage Pit: Distance to nearest well--------------I:-:---Distance f�om-foundafion------------------- Distance to nearest ]of line----------------- ❑ Number of'pifs----------------------Lining ma#erial----------.------------Size: Diameter-----------------------Dept h--------------------------------- 1 Cesspool: Distance from nearest well.-----------------Distance from foundation--------------------Lining } material__-_--__--------------------------. ❑ Sze: Diameter--------'------------'---------'------Depth-------------------------'---'----------'- __----Li Liquid Capacity --- - -- ' --•-gals, -'i€Priv Distance from nearest well--------------__-._ ----Distance from nearest building ------. .� Y= g I ❑ Distance to nearest lot line- - - --i--- ------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------------- --------------------------------------------------------------------------------------------------------- --------------------------------- l----------------------------------------------- ---------•--------------------------------------------------------- --------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------- -------- 0�l p I hereby ce ' y thaf I shave prepared this application and that the work will be done in accordance with San Joaquin County .#. .; l ordinances, St a ws, and rules and re Mations of the Smn Joaquin Local Health District. - k; (Signed)--- --- Signed� -- . . ------ ----- --------------- --- ------------------- wrier and/or Contractor) J ' By:------ -------Qrelaf - --- ------7) gs, -- --------- -{Title} -------------- ,!(Plot plan, showing size of lot, location of system in ion to wells, buetc., can be placed on reverse side). �E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---- - - -------I----------- ------------------------------------------- DATE----- ----- ��Q �" E fREVIEWED BY---------------4----------------------------------- - ---------------------------------------------- DATE-------------------------- 1 BUILDING PERMIT ISSUED __---- - -- -- DATE ' ----------- -------------------------- Alterations and/or recommendations-------- -- ----------------------------------- ------------------------------------------------------•------------•------------------------------------------- ------------------------------------------------------------------------------------------------------- Ei-------•-----•-----------------•-----------------•-------•---•---------------------------------------------------------•----•---- - - ii ----------- ----------------- -- --------------- ------- ----- ------ ---------------------------------------------------------------------------------------------------- -------------- -- --------------------- -------------_------------ ----------------------------------_------------ ----- ----------------'- i ' Date---------- -- � -FINAL INSPETIOJ -3 «� . ,�. - SAN JOAQUIN LOCAL HEALTH DISTRICT , II 1601 f.Hasellon Are. 300 West Oak Street 124 Sycamore Street 205 West 911h Street a Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. a ,� t