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J FOR OFFICE USE: ---------------- -- -- ------------------------------- ------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. G,�. -� 13 ------------------------------------- ---------- (Complete in Duplicate) Date Issued ------------ - --- ------ - ----------------------- -- This Permit Ex_. pires 1 Year„Froth Date Issued //,S 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. r JOB ADDRESS AND LOCATION---.4��_ s__/ _.. -- // I / ,( Owner's Name 'Jli' �- .•41------------------------------------------------------ - ------ Phone------------------------------------ Address____1V•.--y----------O-;L^- --�/----------- ' - ' Contractor's Name ,t ,1�+-rr ,, / n• `-----------------•-------- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1------ Number of bedrooms _3____ Number of baths_ Lot size Water Supply: Public system ❑ Community system ❑ Private.] Depth to Water Table AF__fI_ ft. v 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: t r -(No septic tank or cesspool_permitted_ifrpublic sewer is available within,200-feet.) Septic Tank: Distance.from nearest well---------- ------Distance from foundation-------------------.Material________-___..______-------__________._____._. ❑ No. of c'ompartments--------------------------Size--------------------------------Liquid depth--------------- ------Capacity------ - •----------- Disposal Fiefd: Distance from nearest well--- Distance from foundation..-.?O_______.Distance to nearest lot line___S7._-______ ,( Number:,of lines-------- ---------,-�-------------Length of each line-----�6-�- ------__._---Width of trench._a -'---------------_----- Type of filter materiaj4.4 _:_Depth of filter materia - length_____ ?"____________---__________,- Seepage Pit: DistanceR fio nearest wel -------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material-----------------------Size: D'sameter--------------........•Depth--------------------------------- Cesspool: Distance:from nearest well----------------- from foundation------------------- Lining material__.__---_______________________._-_ ❑ Size: Dia'meter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity---------------------------gals. r Privy: Distance from nearest well__________________------______________________Distance from nearest building-------:---------------------------------- ❑ Distanceto nearest lot line--------- ---------------- - Remodeling and/or repairing (describe):------ " --r'r- -- A - ------ ----------------------------------------'---------------------------------------------•------------- ----------------------------•---------------------------------------------•--------------------------- 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)--- ..� - ----- - --;ter--.�-� .-„BY�--------•• -_ -- -------------------- --- -------------- ----------------_--------------------IOWher and/or Contract --•---- ----- ---------------------- — --- ------------- -(Title)- (Plot 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----- `� DATEG_'_ 3-� ------------------ ------------------ REVIEWEDBY-------------------------------- ------------------------------------------------------------------------------------------ DATE------ - ••-------- �i BUILDINGPERMIT ISSUED--------------------- --------------------------- -------------------------------------------------- DATE__. Alterations and/or recommendations:-,------------------------ I a ---------------------------•----------------------,--------•-------------------------------------------------------------------------------•-------- --•-•-----------------------------------------------------•--------------- -------- -------------------------------- ---- ---------•------------ - --------------- ------------------- •--------------------------•----------------- ---------•-------------------- ------------ -------------------- FINAL INSPECTION BY:_, .� �---- A Date. ''. _.Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.p,ra. M� �3 r