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rvr` vrni,_t UZ�t: --- --------- ---------- - -----------------._ APPLICATION FOR:rSANITATION PERMIT Permit No. ------------ ----------------------------------------- - [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 appli`c7ES�S� sxnaide in,cem i ce w•t Cpunty rdinance No. 549. JOB ADDAND LOCA I N.__ ----- -- / -r r --- ---------•-_-- Owner's Name_____ ,sal- - --- ----------------- ---------• --•------ - -------------- ----- ---------------------------- Phone----- • -• - ------ 40-1 Address---------------r----Contractor's Name___ ----------------------_------•--------------------------------------------- •--- - - -- ----r_ r�•a✓�; - --•--- - --------•----------- -- ----- ---------- --------- ---------•-----•----- ------•----•--------- Phone----------- • Installation will serve: Residence Apartment House ❑ Commercial 4 Trailer Court E] Motel ❑ Other Number of living units: I_____ Number of bedrooms ---- Number of baths _3--- Lot size ll ❑ - __��'-c�---7=__3��------------- Water Supply: I Public system ❑ Communitysystem Y stem ❑ Private ['� Depth to Water Table -$-jb_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EH Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No �j New Construction: Yes jP No ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �- _ Septic Tank: Distance from nearest weil__ara_ __-Distanc f o fou ation___Zd--------Matersai_��i � _ � po No. of compartments----.7 T -----------------Size-- ---7----- ---Liquid depth-----�----- -- - ------- Capacity_..l_S__4_1_._.V----- Disposal Field: Distance from nearest well_S O- -----Distance from foundation___l9-� .__Distance to nearest lot line-_J � Number of lines--------- _ Length of each line----�1LTl_- - D--Vtilidth of trench__- ^- -'' - Type of filter ma+eria / - - --- -Depth of filter material-----�-'�-�'-------Total length---,3:�T_�,(�-Q�_(/`; Seepage Pit: Distance to nearest w �----_Distance from fo ndation____/_0'D_`--.Distance to nearest lot line ------- Cesspool ` Number of pits___-�.---•-----_Lining material_ IT � - -------size: Diameter---��- --------Depth- �-5 ---------��. Cesspool: Distance from nearest welL_______________Distance from foundation-------------------,Lining material---------------------- El Size: Diameter Depth -r---- ------- ---- - - ---- ---------------Liquid Capacity--------------- V' -- ------•--gals.rivy: Distance from nearest well------------------------------------ ----------_-Distance from g nearest building - - Distance to nearest lot line_-..__ Remodeling nd/or repairg -escribf:_.. - ------ r _ p ---- ----- -_ � ------ --------------------- ------ ----------------------- ----- ------- ------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 reg ations of the San Joaquin Local Health District. (Signed)-------- �,_--- �- --------- - - -------- --•------- ---- -- -- -----[Owner and/or Contractor] By:---------------------------------------------------------=-------- -- ----=---=------------------------------------------------(Tifle)------------- ----------------- --t. --� (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-- ------------------------ DATE_!-"-_ '�---- REVIEWED BY----------------- - --- ------- ----•---- �--- - ----------------------------------- ------ DATE - ------------------------------------ BUILDING PERMIT ISSUED----- _-,.------- ................... ---------------- - --------------------------------------- Alteration a d/or recommendati s:__-- _ __ - ------- `f�" �. ----------- , ------------------------------------------------------------_------------------------------- FINAL INSPECTION BY:_,�/ - - - ,t / �. Date ! �. �J6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVIS Ep 8-59 3M 3•'63 F.P.0 O.