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FOR OFFICE USE: $— APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) 7 This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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.-S ----►"!'--- y-,r- --- -------------------------------------- Owner's ---------------- ----- q Owner's Name-___!__L� - ------- ------------ Address---., A------------------------------------- Phone_'y�`�___!__'-'_ .__!_.`3,3 Address- !'------ - -/J---------------------- ---------------------------------•-------------------------------------------------------------/--------------------- Contractor's Name--------- - - ------------- ------__-_---- Phone.-5/ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I3—`� Number of living units: -------- Number of bedrooms ________ Number of baths ________ Lot size -------6 ___________________-_--_________-___-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ' Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------_I No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) t --- Septic Tank: Distance from nearest.well--------- Distance from fooundation-./Q_....___.Mater al_ ------------------_ v2 ------ 7-------_Liquid depth---- 'V- ------Ca ,- ,C2.- �- No. of compartments-- - __._-_.__ Size_- _ ,�. p Y �Q Dis osal Field: Distance from nearest well �.-_--__Distance from foundation__07.4-5---------- to nearest lot line-----------_7___. Number of lines______ Length of each line_____.F-4----------------Width of trench-----a7_ _________ Type of filter mp �_De th of filter matercal__... Total length________________________ -------- 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--------------------____._________-__. ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity------------------------ gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building_____---_-.-.---_____________-____._.-. ❑ Distance to nearest lot line-- --- ------------------ --- -------i-----------------------------•------------``------------------ ------------------------------------------ Remodeling and/or repairing (describe):_._ .-�.------/.... ---- r ----- -- --- -----'~ --------------------------------------------------•----------------------------------------------------------------------------------------------------------- --------------------•-------------------------- --------------------------------------------------------=------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, pnd r les and regulations of the San Joaquin Local Health District. (Signed) ----------- -- ------- caner and/or Contractor) ------------ ---- ------ - ----------- ---�-J 0 By:__ -- ------ - ---'� -----------------(Title) V__ -------------------._.-... -------- (Piot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------------ APPLICATION ACCEPTED BY---/4-:-- -- -- ----- ------------------------- ---------------------------------------- DATE-- REVIEWEDBY------------------------- ----------------------------------------------------- --------------------------------------------- DATE--------- ------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DATE----------------------------------------------------------- Alterationsand/or recommendations-------------- ---------------------------- - ---------•-------------------------------------._..-------------------------------------------r---------------- ------------- ------------------------------------------------------------ - -------------- -------------------------------------------------------------------•------------------------------------------------------- ----------I--------------------------------------------•----- ------------------------------- --------------------------------------------------------------------------•--- -------------------------------------------- Pl�FINAL INSPECTION BY: --'-�'-�� Date . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California p ES 9 REVISEO 9-59 31A 3-'63 F.F.CO. '