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FOR OFFICE USE: ------- - ------ - - __ _ - ,.-5----------------------------------- -<e�-- APPLICATION FOR SANITATION PERMIT Permit No _...... r_:� . ---------------------------------- (Complete in Duplicate) ---.--- This Permit Expires I Year From Date Issued 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_.._.�_?�' O--------�7veo ------- O�.�JC�/Y Owner's Name--./// Akp"nl�S------------------------------------------------------------------------ -- - ---... Phone-- � - --- ----- Address...........4�' ..2-6 ............6;� c Contractor's Name--------�7nA9..:---r ' li r_ISf' _.__ rSQ1ll ----.---/ e-'----------------------•-- Phone.. _ 'G4 -- ' Installation will serve: Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms _3.. Number of baths _Z.._ Lot size __1/1K/____-./Y_______,llo______________ Water Supply: Public system [P/Community system ❑ Private E]" Depth to Water Table _b1O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyLoam ❑ Clay Loam ❑ Clay ❑ Adobe Ejr Hardpan ❑ Previous Application Made: (If yes,date- ---- ------ No R, New Construction: Yes [ErNo ❑ FHA/VA: Yes ❑ No .t 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---- pMateri I___0'�1'�� e ® No. of compartments------__-_______.__Size__ ,K,� __ _-___Liquid _s-----____--Capacity�AO-220-__ssf/�1 Disposal Field: Distance from nearest Distance from foundation___.�Q---____._-Distance to nearest lot line____s' ----------` Number of lines__________ ____________ _______Length of each line__1A'�—_- .f�_�_.Width of trench______________` ____"-_-- Type of filter material_ AaA ___-_Depth of filter material__,,4g".......Total length--------------- _6-0----_____-- Seepage Pit: Distance to nearest weli_Z __Distance from foundation__1Q..........Distance to nearest lot 9 Number of pits-------Z----------Lining material__,r 6C_._Size: Diameter....... ��_--Dept h.........._2,17_.__..____. F Cesspool: Distance from nearest well-----------------Distance from foundation__-.______.____._..Lining material-_--_-.____.___.____.______--__-___-. Size: Diameter----------------------------------- Depth --gals, ❑ - P -- ----- - ---------------------Liquid CapacitY---------------------- - Privy: Distance from nearest well-----__-----------------------------------------Distance from nearest building___.__.___--------------______..__..__---- ? ❑ Distance to nearest lot line ----------------------------------------------------------------------------------------------------------- . F ' ---------------------- Remodeing and/or repairing (describe):____ 7�� _______________________- - .______/ --------------------- ---------------------------------------------------- --------------------------------------------------------- ---------------------•-------- ------------------------i--------------•------------------------------------- ----------------------------------------------------•----------------------------------I------------------------------------------------------------------------------------------------------ ------------------------------ 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. -� - r --------------- (Signed) � _ _______________________________ weer and/or Contractor) BY=------------ -� -r--------- --------- ------------------------------------------------------------(Title)----- ------------- ---------------- -- -------------- (Plot plan, showing size of Iot,�Iocaon of system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPA"ENJ USE ONLY APPLICATION ACCEPTED $Y-- ` +' DAT ----------- REVIEWED BY ---- -------- DATE ------------------- ----- ------ ------------------------•-------- BUILDING PERMIT ISSUED-------------------- --------------- DATE-------------------- --------------------- ----------------- - �Alterations and/or recommendations --------------•-------------------------------•---•--------------------------- ------------------------------------------ ---------------•---------- ------------------------------------------------------------------ -------------------- ---:---------------------------------------- -------------------- -------------- -•---------------------------------------- ------------------------------- ---- -•-=-------- -•----------------------------------------------------------------------------------- ---------------- ----------------- --------------•--------------------------- ------ -------- --- ------- -------- •-•-•-------------------------•--------------------•----------------•- -----------------------•----- -------------- --------- ---•-•- ------ ---- ----------- -•----. •----- -------------------- ---------------------- ---- ----------------------- ( FINAL INSPECTION . � ---- - - ---- --- - ----- -- ------- Date---�- �----- SAN JO IN L AL HEALTH DISTRICT 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t E9 9 REVISED 5-59 3m 3•'63 F.P.CD. 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