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FOR OFFICE USE: � 6-�---------------- ---- ------- �Y� -- - .......... ...._---___-___.-------_.-__ -------------- APPLICATION FOR SANITATION PERMIT Permit No. _-j__. ------------ -- -------- ----------- ------------- (Complete in Duplicate) f ----------------- This Permit Expires I Year From Date Issued Date Issued Application is hereby made fo 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_•--_______tom -- ----_-_-,---- _ -------------------------------------------------------------------- Owner's Name---------------------ler-1, t- I.......... " Phone -------------------------- Address------------------- Contractor's ----------------- Contractor's Name------------ -44-�)--------• ----- Phone----------•---- - Installation will serve: Residence JN Apartment House El Commercial C) Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms __ Number of baths _1-___ Lot size ____, Water Supply: Public system W Community system ❑ Private ❑ . Depth to Water Table -1.67 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: (If yes,date-.'7'-I .:a �_} No ❑ New Construction: Yes ❑ No FHA/VA: Yes a 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 well----------_------Distance from foundation--------------------Material __________-___.______.___________-_--____.-___. ❑ No. of compartments--------------------------Size__ ------Liquid depth---------- --------------Capacity FieDistance from nearest well------ Distance from.foundation----/o_/-------Distance to nearest lot line Number of lines-------------/--------------------Length of each line----------//4�-"------.Width of trench------ �'--'---------------- o � Type of filter material__S__40?c�____Depth of filter material----. 7� -------Total length________qC1_____________________.__._ '1l Seepage Pit: Distance to nearest well------_---------------Distance from ,foundation--------------..__..Distance to nearest lot line_____-----____.__ � ❑ Number of pits----------------------Lining material--------------:--------Size: Diameter-------------.---------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_------------------Lining material------------------------------------- El Size: Diameter--------------------------------- ---Dep#h------------------------- -------------------------Liquid Capacity-. -------------------------gals. Privy: Distance from nearest well-------------------------------_---_-_____-_____Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line-------- -------------------------------------- •------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------14-0-Z-----------4- ------------'*'� /,� ------------•--------------------------------------•--------- ----------------------------------------------------------------- --------23------------------------------------------ ----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)--------------------------------------------------------------------------- -------------- ----------------------------- ------- ----------------------------------(Owner and/or Contractor) BY: ------------------------------- --- (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--- -------------- DATE--- - REVIEWEDBY--------------------------------------------------------- ---------------- -------------- DATE BUILDING PERMIT ISSUED --�_ DATE or recommendations:_-----_-__ / Alterations and -- _-- 'e'd-------------------------------------- •----------- - G -- ' ----------`-'�L"7�a � �o��l�r Y ��-------------------------------- ------- ---------------------------------------------------------------------- -------------- ----------------------------------------------------------------- ------------------------------------ ---------------------------------------------------------------------- --------------------------------- --------------- ---------- -- ------------------------------------- ----------------------------------- -----------------------------------•- ----•------------------------------------------------------ ------------- FINAL INSPECTION ---------- Date----- ------ 7.---- ----------5 ----- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT' 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California • Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Q0. 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