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FOR OFFICE USE: ------- --- -- ----_ .----- -- =------ -'��---- �`� -------------- APPLICATION FO-. SANITATION PERMIT Permit No. --------- ---- C---- (Complete in Duplicate) � ---- - ---- This Permit Expires 1 Year From Date Issued 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 �- Zz" l' J Owner's Name --------------------------------- --- Phone Address- ---------------- ii --.---- --------•--------•----------------------------------------------•-----...--•------- Contractor's Name______________________ - - J -------------�----- --------- - - -------- Phone..__..--•-------- - -------------- ----- - , Installation will serve: Residedc�0-�Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __2. Number,of bedrooms,3__-- Number of baths _--Z Lot size Water Supply: Public system Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand D Gravel ❑ Sand _Loam p Clay Loam ❑ Clay El Adobe ardpan ElPrevious Application Made: {if yes,date- _____________] No � Ne, Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ NoG 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_____.-.__- 60/,5,t// LNo. of compartments--------------- -----------Size--------------- ---------;- ---Liquid depth-_"----------- - CepacitY Disposal Field: Distance from nearest well.-.- -------Distance from foundation-,/.P------_-Distance to nearest lot line___ Number of lines-------__ ----- ------_------�r------Length of each line___--- /i g Width of trench -----------•--------- S �l f*�n.�� e of filter material____)1iT-'1 a��__Depfh of filter materiaL-_.)-"�-��-------_Total r Seepage Y Distance to nearest well--------- Distan rorn . ndation__1_v_y-------Distance to nearest lot line__.S_-�---- r Number of pits-______--- — R�/ Lining mater al �� Size: Diameter ..........Depth---- •1------- Cesspool: Distance from nearest well_________________Dis nce fro oundation_._._____-_________.Lining material_____-__-.------------------------- Size: Diameter_____________ ----------------------------- Depth----------------------------------- ------------- Liquid Capacity---.------------ apacitY- ------------- --------gals. T Privy: 5 Distance from nearest well --------------------------------Distance from nearest building •Y ---------------------------------------- - D ❑ Distance to nearest lot line-------------------------------------- 1 Remodeling and/or repairing (describe); ------------------6 ` ^-v --------------•------•---•----------- ------------------------------ ------ ------•-•----------------------------------------- t ----------------------------•------------- W. I------------------------------------- --------------------------------------------------------------------•--------------•------------- =r F_ --------------------------- I hereby certify that I have prepared this application and that the work will b- done in accordance.with San Joaquin County ordinances, S}ate s, and rue d re ulations.cf the San Joa•quin_Local-Health District. (Signed) - ----- ------ Q ----- --------------(Owner and/or Contractor) I 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------------ _ ________ V-7- ------------------------------------ - - DATE-----REVIEWED BY------------------------------------=---- DATE----- --------- ------------• ------------- --- UILDING PERMIT ISSUED------------------------------------ "_ ."` ------------ DATE Alterations and/or recommendations:____________________ ------------------------------------------------------------------- -----------------------------------------I--------------------------- FINAL ------------------------------- - - FINAL INSPECTION BY:-----------------/-._- �'�_ -----•----- - - -- Date------- - s-�� '------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ' 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ''Manteca,California' _ = '=Tracy,California ES 9 REVISED a-59 3M 3-•53 F.RCI7,