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F R OFFICE USE: �- -------------------- -` ._ ! ---------------- -- ---------- APPLICATION FOR SANITATION PERMIT Permit No. -------- ----- - -------------------------- ------ --- (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 constru t and install the work herein described. Thisplication is made in compliance with County Ordinance No. 549. yvl rG E A)OP-T-H �Z,t� nor t4,g uJ r FJta�'! . :. DN -JOB ADDRESS AND LOCATION_k--- --- ----- - ------- � Lw� 2>XgN ---- Owner's - Owner's Name------YYY_ --- 0- __Z__e-1V------------•--------------------- t Phone--S-�7--3..`- e3- Address--------- { rn L� -------------------------------------------------•---------------------------------------------------------------------------------------•-•------------------------- Contractor's Name-------- Af. [? -`7A---------E.t,4_C----------------------------------------------------------------------------- Phone__`k..4._-C1_-6-P-7--- installation will serve: Residence Apartment House Commercial Trailer Court Motel Other Cl hreiEr�rJ ❑ p ❑ ❑ ❑ ❑ � c..00As Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size __ _1------ - 4- --F--------__________________ 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 U Adobe❑ Hardpan Previous Application Made: (If yes,date____...... ........) N o7 New Construction: Yes ❑ No W FHA/VA: Yes ❑ NoW 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_____.____________-_t___________.._________. E] No. of compartments_________-----------------Size---------------------- -• --___Liquid depth------------------------- Capacity---;------------------ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-------.._____... ❑ F � Number of lines------------------------- ------Length of each line------------------------F----.Width of trench--------- _---------------- Type of filter material--------------_'---------Depth of filter material-----------------------Total length------------------ _.____________________ Seepage Pit: Distance to nearest well___ Distance from foundation------1_d........ID-istance.to.nearest.lot line----s5___-_____- N o_,4c4. Number of pits-------- ----------Lining _.Size: Diameter-------- O"-_.___.Depth_.-------..- �_'------------- _ . 1 Cesspool: Distance from nearest well-----------------Distance from"Ifoundation-------------------.Lining material_______----.______________.________- ❑ Size: Diameter---------------------- ---------------Depth---------f-----------------------------------------Liquid CapacitY- ---------------------------gals. Privy: Distance from nearest well-----------------------------------______________Distance from nearest building-_-.------------------------------------ F1Distance to nearest lot line----------------------------------- -------- ----------------------- ---------------------_-"-------------------------------------------- Remodeling and/or repairing (describe) --------6------ .......... -------------------------------•--------------------- 11 ----------------------- ----•-----••----------------•---------------------------------------=--i---------------------------------------------------- --------------------------------------------------------- ------ --------- -------------•-- -------------------------.------------------------------------------------------.............-•----------------_.-_-------------------------------------------------------------------------------- P_ ---------------------------------------------------------------------•------------------------------------•-------•------------------- ----•---------------------------------------------------- -------------------------- 1 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 N "------------- - ---------------------------------------•------- -----------O ner and/or Contractor (Signed)------ ------ { ) r s ^-�- - {Title) --------------------- ---- (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - ---- _ —----------------------------------- DATE------- �V- . -->__-------------- REVlEWEDBY. ---------------------------------------------- DATE---------------------------------------------- BUILDING PERMIT ISSUED = f -------------------------------------------- DATE---------------------------------------------------- Alteration and or recomme Tns:- - .! fa10-- --- -Y---- ---- ------------------- ------ ---€------- --/�------------------------------------ -- •-------------------------------------------------------- ---------- --------------------------------- --------------------------- --------------------------- 4 t I --------------------.---------.------.___.__ ----------------------_----------------------------.___'t______.-_.-__._____.____________._._______-._._________._..___._ FINAL INSPECTION BY:..-- ----------------------- Date--- U ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ` Tracy,California ES 9 REVISEC 8-59 3M 3-'63 F.P.CC. t