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FOR OFFICE USE: ------------------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. __19�zs% ------------------------------I---- ------- ------------- {Complete in Duplicate) - This Permit Ex ices 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. 01r- :in?,?.3 r C _ itEf c:-S i y� JOB ADDRESS AND'LOC TION----'9! _W6P--- ,/ A / +{...i<t'1-- -'------•-%( ------•- Owner's Name----- ' —' Phone-----.."--------------------•-•----- f Address �� A -------•-----------"--------•---•-••-•--------- ---- -- - --• -------------------- - Contractor's Name-------6l--_-'--�-------------- �a �1-----•--•-----•----------- ---- ` Phone. . e _�! Installation will serve: Residence go Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms __A-_ Number of baths __l-._ Lot size ___________________________________ Water Supply: Public-system M Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand W Gravel .❑ Sandy Loam a Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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"_1'Q1------Dist a f om foundation-----19— ------.Material--- p� No. of compartments___-.rte___-_--.______._.Size_ s___._=.___Liquid depth___�/_-.______._____--Capacity.Z __! ___ Disposal Field: Distance from nearest well_X4_.'�__._._-Distance from foundation--;2-i;7---------Distance to nearest lot line---Ald�_____ Q Number of lines---Y._______ ____-- ----Length of each line 0,�_ � __ "._.______-__"Width of trench___ �_�---------------------- �. Type of filter material __Depth of filter material---Ar --------------Total length ---------------------------I 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 material__-_______________________________-._. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_.------------------------gals, Privy: Distance from nearest well ___--___________________Distance from nearest building____.____________________________-.____.-. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- ------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------••------•-------------•---•-------------------------••------------------------------------------------------------------------------------------------------------ -------- •----------------------------- ------------------------------- •---------------------•--------------------•----------------------------------------------------------------------------------------------------•-----------•-------------------- ------------------------------------ ----------------------------------------------------------------------•--------------------------------------------•------------------------------------------------------------------ f I hereby certify that 1 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. (Sign ��JY _ 1-- -' ---- - -------- -----------------------------------------------------------------------{Owner and/or Contractor) _. 4f/. By:-------------------------------------------------------•----------------------------- --- -----------------------------------------(Title)---------------------- ----------- ------=--------------------- (Piot 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--------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------- --------------------------------------------------------------- DA-Te•-------------------------- --------------------------------- Alterations and/or recommendations-------------------------- ----------------- - --------------------------------------------------------•----------------------------------------•-•---------•- ---------- ----- --------------------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------- -------•------------------------------------ ---------------------------=-----=----- -------------------------------------------------- --------------•--------------------------------------------------------------------- -----------------------------------------------------------•-------•---------------------------------------------•--------------------------------------Q--.."----------------------------- --------- - FINAL INSPECTION -------------------- --- Date 'l. - ------------ -- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.1fa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3"'63 F�P.CO. ~-