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FOR OFFICE USE: -------------------y' -`y - _../ v � :1,_0_U__. APPLICATION FOR SANITATION PERMIT Permit No. _yS��_..._ r ------------------------------------------------ ------ (Complete in Duplicate) Date Issued --------------------------------------- ----------------- This Permit Expires 1 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 3-f, Owner's Name ------ - _ 4. - . -------------------717 _ Phone Address «5 3 - ------- '----------------------------------------•------------- -------------------••---------------------- ----------------------- - ----------------- - f Contractor's Name------ - ---- ----• ---�,..7A---------- ---=-------••--------------------- ------ ----------- ------ Phone------._--------•---------•-------- a Installation will serve: Residence M-'Kpartment House ] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms _2— Number of baths __/___ Lot size _3 A__l Z4__'____________________________ Water Supply: Public system E�ommunity system ❑ Private Ej Depth to Water Table XP ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe;• -ardpan ❑ Previous Application Made: [If yes,date___ _-_.-- } No [, New Construction: Yes P•- wo ❑ FHA/VA: Yes ❑ No [�jl TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic k: Distance from nearest well_ _____ Distance from foundationjb___--___._.-___Material____._{__1_ ___________________..______ ___ No. of compartments------I --------------Size--------3_ b" C_c!__Liquid d*pth__"s(--------------- ----Capacity-_4r( Disposal field: Distance from nearest well..~.____._Distance from foundation-_&- Distance to nearest lIfr ot Number of lines________ ___ Length of each line___Q_o _-----------------Width of french-._.Z. ------------------- Type of filter material ' __ _ __Depth of filter material--ft---------------- Total length ------------------------- Seepage __-_______._____________See a e Pit: l Distae . � fo-undation__ A_ _ Distance to nearest lot 7C -Nurnber of Pits_______I------------Lining material____( Diameter__._2�_. _______De th------Al-i0ne6 Cesspool: Distance from;nearest.well------------------Distance from foundation--------------------Lining material__._.________-___._._________________- F Privy: D to Diameter---- -------------------------------Depth----- ----------------------Liquid Capacity. --------------------------gals. i from nearest well_:___________..__ _Distance from nearest building _____________. G Y ---------------- _ 9 ❑ Distances to nearest lot line----------------- --------------- ------------------------------ Remodeling -------------•--------------Remodeling and/or repairing (describe)----------------------------------------------------•----•--------------------------•-•------•-- ----------------•-••------------------------------------ ` i _ __ 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. (Signed)------------------- ---------------------------Al.------ ------------ --------------------------------------------------------•-------------------(Owner and/or Contractor) t Y• ------------------------------------------------------------------------(Title)---------------------------------------- - --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc., can be placed on reverse side). e s e f I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE y-------------------- - { REVIEWEDBY-------------I---- I--------------------------------------------- -------------------'------------------------------------- DATE---------------------------------------•---------------:--- BU1LDiNG PERMIT ISSUED----------------- --------------- 4------------------------------ : + DAT Alterations and/or recommendations _ , -------------------------------------------------------------------------------------------- ------- ----- - ------------------ `----- -------------�------------ ------------------ ------------ •-•------- ----------------------------------------------------------------- ------------------------ { FINAL INSPECTION BY:_ err.` �� J Date-- �C7 ~� � - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,fCalifornia Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-163 F.P.ED.