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rva< llrrll,C VJC: -- ------ A ----- ------------------- ------- -pI--------------- ----------------- APPLICATION F'OR SANITATION PERMIT Permit No. ------------ ----- ------------------- ------------------ (Complete in Duplicate) ---- ------------------ -------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _,l -�f�`-�I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor rein dX.red. This application is made in compli e with County Ordinance No. 549. p/ C 2 q`Z-d n1 f r r56rt�,O a-0-- r JOB ADDRESS AND//. LOCATION_. -/_, Owner's Name------- ________ _ 9 - _� -----------------------------------------�f - .. Phone.--...------------------------------ Address--- " e r. -/� 1� �4 f I Contractor's Name--------•�4P'�---= �-'-------------------------------------------------------------------------------- Phone..__-------•------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Motel ❑ Other ❑ Number of living units: _`___- Number of bedrooms _ Number of baths Lot size . ',( :__•-------_--- ---- Water Supply: Public system ❑ Communitysystem y ❑ Private [�''6epth to Water Table 4;� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay g? Adobe ❑ Hardpan Previous Application Made: (If yes,date--------------------) No New Construction; Yes ®-'No ❑ FHA/VA: Yes 2�'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu�b+lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- from founcl tion___el7______-_.Ma eri l�/' &!-::97 ,/ ----------------- ��" No. of compartments---A_____________`___Size�!`_6__-3_ Liquid depth_ /---_.._______.Capacity__ -_---• Disposal Field: Distance from nearest well-1-$_40......Distance from foundation.,�f----------Distance to nearest lot line.,`_11�7_-`�.. i Number of lines__ r ---_----`_-�-- Length of each line--- -----------------Width of trench. ------ ------------------- Type of filter material <Depth of filter material__- «-....Total length__Cl7a_`_____________________ Seepage Pit: Distance to nearest well__l -_f--Distance from fou dation_±-27.�--__.Distance to nearest lot line_1' - _ - [Lf� Number of pits---.______________Lining material__/ Size: Diameter_�d-"_- 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):---------- �� .... . /� -- -------------------------- �?------ -- ---------- -------- ----------------------------------- J...- - - -- - y -----------------------------------------••--------------------------------•-------------------------------------------------------------------------------------------------------------------- ------------------ 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)----------------....... 'C� -�� ----------- -------- - - ---------------------------------------- ----------(G*ymr-vt*or Contract By--------------------------------------------------------------------------- -•-- " _ title -- -------------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------- --------------------- ----------------------------------------- DATE REVIEWEDBY--------------------------------------- --------------------- ------------------------------------------------------------- DATE----------- BUILDING PERMIT ISSUED------------------------ DATE---:---•-------------------_---- --- ------------- ------------- Alterations and/or recommendations:_.__ ._f.-__---_-- ----- --------Q_-__-__- !Y C-,S ---------------------------------•--•------------------------•-------------- -- --------------------------------------------------------------------------------------------------------------------------- --------•------------ ------------ -------•--------------------------------Z ------------ --------- - ------------ ---------------------------- FINAL ------ ------------------ 1 FINAL INSPECTION BY: Date ... . �_ _4w� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.Gq.