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OR OFFICE US o `' a fes. 5 !� APPLICATION FOR SANITATION PERMIT Permit No. . .-----..-- . --- -- ------- �E{/Al 3a ----------------- -------------------------------- --- (Complete in Duplicate) Date Issued .....a/ G ------------------------------------ This Permit Ex fires l Year From 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 N?. 549. 3 JOB ADDRESS A C TION-_ - -d.-•--------- ------ -• ... ----------- ......... .................... Owner's Name •------ Phone------------------------------------ -- -- Address--- /.D _. ---- --- -------------------•---------------------------•-----------------------------Phone---•---------•------- ------------ ------ ` .---- --- •-----•----- ........ Contractor's Name.----�- -----------•---- --------------••---------------------------------------- Installation will serve: Residence [Apartment House E I Commercial ❑ Trailer Court ❑ `Motel ❑ Other ❑ Number of living units: .--._.•.Number of bedrooms ! t Number of baths I--- Lot size .___ ?.°? --- •--- 'r•-------•--.. 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 ❑ 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.)j 1 Septic T nk: Distance from nearest.well__ __-.__Distance from foundation.�d-------.......Mafienal_____I__.___..-___..______........_..._......... ( Size SX Li uid depth------ --- ----------Capacity------1911, ��•- "\ No. of compartments----- -Z..----- 3 X`_-.--- r -- q r Disposal-Field: Distance from nearest well__.___._Distance from foundation_��.............Distance to nearest lot line_.__.....__...._. 41 !r Number of lines.______._/.4----------------------Length of each line_____ --- ------------ of trench._..____.y___....______.-__-••.. ' b f " { Type of filter material.-.'--G --------Depth of filter material__1_k.______________Total length---...�®.._........_....___.... Seepage Pit: Distance to nearest well_-��___-.______Distance from foundation___-�1!__r.__._•.Distance to nearest lot line---�...___._ � i Number of pits__...----1-•--•------.Lining material.-----f[ca r✓ --.Size: Diameter----....--3- --- Depth__-__Z r.................... W Cesspool: Distance,from nearest well___------------Distance from foundation_-----------------Lining material..__._.___--______-____•----.___...._ ❑ Size: Diameter--- I---------------....Depth_--------------------------------------------------Liquid Ca aci gals. } ------------- ------------------•------------Distance from nearest building----_.___--------------------------------- Privy: Distance from nearest wel-- G _ ❑ Distance to nearest lot line-------------•--------------------- :----•---=------------------•--...-•----...--•-------------...-------------------------------------------- ---------------•----- Remodeling and/or repairing describe ----------------- ----- .... ------•----------------------------------•-•-----•------•-•------ -..-------- •- ---------------------------- -------------------------•-----------------------------•-------------------•------------------------ ---------------- I hereby certify that I have prepared this app' -.d-.-.o and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the an Joa uin Local Health District. ----------------(Owner and/or Contractor) (Signed)_ --------------------•------------:---------_------------------ - ----- t I Title By:_-••-----------------•----•-----------. ...--------- �- -------------- --------- -- -•-----------------•--- --- (Plot plan. showing size of lot, locatio of system in relation t walls, buildings, etc., can be placed on reverse side). F FOR DEPA, TMENT USE ONLY APPLICATION ACCEPTED BY------ •- - -- -- ------------------ ------------- DATE--- r .7� ------------ REVIEWEDBY_-----------------_---- DATE---•-----------------.-----------------------•----------•-. FBUILDING PERMIT ISSUED------------------------- ---- --------•-•--------------- DATE-----------------------------------------------••----------- AFterat'sons and/or recom endations:.. •---- --------- ----- r ! :_- — s ------------ ----------------------------- ------------------------------------ ---------- ____________ _______________________________________________________________ -------------------------- _______________________________________ S _______ -------------_-----------------________ --------------------------------_ _ ` ._ -.._ ___ ...__-_ FINAL INSPECTION BY-------- ------'----_-- - ---- -- -------- Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT . 130 South American Street 300 west oak street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracyr California E5 9 REVISED 8-59 YM 5-61 AYLAS