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FOR OFFICE USE: -. 1M APPLICATION FOR SANITATION PERMIT Permit No. _.-. 1fr -------------------------------------- - ---------------- ------------------------ --- -- (Complete in Duplicate) 14 iM Date Issued _ 1.__......1,6 y 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 insfall the work herein described. This gppiication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. A --- ate`----- - ----------- ------------.'�----------- Owner's Name_ '► -.-.... �j -ra-----------------•------ ------------- ----------------------------- �•---------- Phone------ Address----------------------- -----------•---------------------------------------------------•----•--•---•- Contractor's Name--- t Installation will serve: Residence, Apartment House E] Commercial ❑ Trailer Court, Motel E] Other E] Number of living units:;' Number of bedrooms -------- Number of baths -------- Lot size __�7 _ ---------------------------------------- l. Water Supply: Public systemll�❑ Community system El Private E] Depth to Water Table ..6---- ft. i, Character of soil to a depth of 3 feet: Sand k Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Ilf yes,date--------------------) No jL] New Construction: Yes ED No ❑_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: *�J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation----.--_-_-- --.'.Material------------_..-------.-----------..-----.------. :j ` \( ❑ Noof compartments--------------------------Size------------------ ------------ Liquid depth--------------------------Capacity----------------------- Disposal f=ield: Distance from nearest well.-cr0i ___._.Distance from foundation--- ---------Distance to nearest lot line--s-' _------- ] yp lines--------�_-------.. _ Length of each line------5-�'---------------Width of trench---A.V-1'-.--------------------- .7 e of filter Depth of filter material` Q.!r-.......Total length.._V------------------------------- Number of _ ter materEa)�._.___...___ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line-------.----_-_-_ ❑ Number of pits---- +- Lining material-----------------------Size: Diameter----•------------------Depth--------------------------------- �i Cesspool: Distance from nearest well-----------------Distance from found'ation-------------------.Lining material--.-._._----__-____----.-..-_-.----. Size: Diameter--------------------------------------De th---_.-.------'.---.------ ------------------_Liquid Capacity ----------gals. Privy: Distance from nearest well-----------------------------------:--_Distance from nearest building - . ❑ Distance to nearest lot line e-�-------------------------------------------------------------------- -------------------------------------------------- -------- --'---------- I4 G --- Remodeling and/or repairing �(describe): ---- - ------------------�----�'--- /- / ----------------------------------------------------- ---•----•-•---------------------------------------I-------------------------------------------------•------------ -------------------------------------------------- ------------------------------------------- ------ II, -----------------------= -------------------•----------------------�--------------------------------------------------------------------------------------------------- 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. (Signed)----------------------- .--------------------------------------------------------- ----------------_-----(Owner and/or Contractor) -(Title)------I---------------- --- (Plot plan, showing size of iot,lflocation.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y/,;? =------------------------------------------------------------- DATE-----7 ---------------------------------- M REVIEWED BY------------------------------------------ ----------------------------------------------------------------------------•-•- DATE-------------------------------------------------------------- ... BUILDINGPERMIT ISSUED---=I' ------------------------------------------------------------------------- DA•TE-------•---------------------------------------------------- Alterations and/or recommendations--------------------------------------------- -----------------------------•--------------------------•-----•---------------•--•--•-•-------------•--------- 'il Il -----------------------•------------------------ •------------ ------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------•- ------------------------:------------ ------------------------------------------------------------------------------------------------------------------------------------------------------- ----- I r FINAL INSPECTION BY�� G"� 1� -------------------- Date "�6 - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i Lodi,California Manteca,California Tracy,California es 9 REvisEo B-59 3M 3-'63 4 � f