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FO OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) - Date Issued -----------------.t This Permit Exuires i 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 No. 549. JOB ADDRESS AND LOCATION � L-----------------------------° ,/ Owner's Name Gdiv----- --------------------------------------------- --------------•--------------------------- Phone.,34.� 6--5 7- Address--------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name--------- t_____: _______________ Phone__ Installation will serve: #Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑., Number of living units: Number of bedrooms :- ___ Number of baths --/--- Lot size .!fes......X'-_.6e- '_____________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4;2_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6eff Hardpan ❑ Previous Application Made: (If yes,date______________________) No 15 New Construction: Yes ❑ No )' FHA/VA: Yes ❑ Nom' 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___: -------------------------------------- __________.____.Materia `.._--_-_.. ❑ Frj&I" f No. of compartments--------------------------Size---------------------------- ---Liquid depth----------------- --------Capacity---------------------- Disposal Field: Distance from nearest well''&*h __.Distance from foundation__1_o___`-_____.Distance to nearest lot line------ -___._ ' Number of lines-------------- ---------_---------E_ength,of each line____-___--3s_i________-Width of french----------- _f .'..______._ { Type.of filter material__�e /C__Depth of filter material-___,�:.,�''______Total length-------------------L-:-'�'-______-- Seepage Pit: Distance to nearest well--?i ___Distance from foundation____1L>_.........Distance to nearest lot line_____') 64 ajLl Number �f pits-------e------------Lining materialc5'- et/e-Size: Diameter-----cO�3.......Depth-------_-- y-1------------ Cesspool: Distance from nearest well_________________Distance from foundation-------------.------ Lining material__.______,_.-______-_.____.______- 6 Size: Diameter-------------------------------------De th----------------------------------------------------Liquid Capacity ------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building------_---------------------------------- ❑ Distance to nearest lot'line-- ----------------------------------------------------------------------------------1------------------------- - --' Remodeling and/or repairing (describe):______ ---------73-..___ t _/ ----------------3 'S ref-1--------------------------------------------+ -------------------------------------------------------------•------••------------------- ----•-------- :•--- •---.---- i ` t m- V ----------------------#--------= ..e - - -------7 �=--f--- - — -7- -------------------------------- ------- ----------------------------------------- --------------------------------- -----------------•--- - �. ' 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. Owner and/or i (Signed)--------------�� ---------' ----'�-'Y^�'=�---' - �-----------------------------------------------------------------( � Can+rat+or) i BY - (Title) �------------------------------ = --..-------- (Plot plan, showing size of lot, location of system in relationjo wells„buildings,;etc.,.can:be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -- -`--- c-------------------------- ---------------------------------------- DATE---------------------------6Z --- ---------- REVIEWED BY t ------------------ DATE-------------------------------------- BUILDING PERMIT ISSUED-------------------.-------------------- ------- DATE Iterations nd r reco men flc . ------------ -------------•--------------------------------------- --------------- - (�''° �! ' �------ ';> ----- ---------------------- '� ' -` �+-� -------- ' ------- ---------------------------- - y ---- ------ ----- --- ---------------------- --------------------- ------------ _---_--_-----.---___-__-_------ __-----__.--.----._.-__ ------------------------I ____---__._ ------------------------------------------------ __.____----------------------- ----------- t k FINAL INSPECTION BY:..---- ` T=, -Q----------------------------------- Date d ......... -- --...................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Streetlw 205 West 9th Street Stockton,California a Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.00.