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FOR OFFICE USE: 1 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..��/1./-... ---- --------------------------------------- - -•------ (Complete in Duplicate) �// � Y ---._._-. This Permit Expires 1 Year From Date Issued Date issued .___..... 7...... ----------------------------------------- - --- �s/ 30 Application is hereby made to the San Joaquin Local Health District for a permit to construct and i all ?e.work herein d�scrbed. This application is made,in compliance with County Ordinance No. 549. t� /J •-••- -----•- ---- -- JOB ADDRESS AND�LL CATION / - /` f. '` � . r.. = Owner's Name------- .. ... .....•-�„/!' �" w - -------------------•------------------------------------•-------------- Phone..."-•- •-----...... •---_---_ Address------------eon" ___e..-•-- -=--._...._."...----•-----------------------------•-•--•------..."----------------------------_......-.-•------------------••----.... } Contractor's Name.. --5------------•--•---------•-----------------•-.................... Phone..--_-----_----- Installation will serve: Residence e] Apartment•House ❑ Commercial ❑- Trailer Court Motel ❑ Other ❑ v 1 - ------- Number of living units: _�_._.. Number of bedrooms ."� Number of baths _�... Lot size •_ _ _�_.__.__. .. . ____________________ Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table 7.0.. it, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam IN Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No J New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ € TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool•permitted if public-sewer is-available within 200 feet.) - R - - I Septic Tank: Distance from nearest well_r_�+_rQ.... Distance from fou dation._0___._......Material__ .YI ....................... A No. of compartments___x-___________..-::-Size-91 ..?+---k------Liquid depth...... -----------------Capacity-Af-920_....... tfi Disposal Field: Distance from nearest well__---------Distance from foundation____/A._........Distance to nearest lot line...►......... Number of lines....., Length of each line_____741------------------- of trench._A-V.#-_----.___"-____...__ i _ _ I Depth of filter material._f�f_-----------Total len th__._./.c1`_.*.------------------------ It ----------"-•- 7ype of filter material/e ._�_._ ._- -_ p g •-•- Seepage Pit: Distance to nearest well_-f ----"_:__Distance m f ndation_JQ_'.............Distance to nearest lot line__........ . Number of pits...�_A--------------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--------- -------------------•--"---------- --------•--•------------------•---------•----•-------------- Remodeling and/or repairing (describe)-----------_-----------------------------------! ' 1 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. i (Signed)------------- --•--� i ---------------------------------------------------------------------------------------- Owner and or Contractor) BY--- --------------------------------.-•---------=----------=----------------•----•-•------•-------------------(Title)-------- -------------•--------------- - ----------------- 1 (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------------•-------•--....------------------ -------------- BUILDINGPERMIT ISSUED—..........------------------------------------------------- :-------------------•--..._..-- ----- DATE 4 -------------- --------------------------- Alterations and/or recommend ions—.-A-- _".- -.��------=.......f& .---• ---------------- .....W"-�' �"•-•- ex- _ ..... ; ---- ----- o._Kl---------0... .. � �2� ----- ---------------- -----•------------------------------------------------------------------------------------------------ -------------------------•---•--------.-- t--------------------- ---------------------------------------- ----- • -•---------- ------------------------'--'--------------------------------------------_._._..-------------------------------------------------------------------------------- r . F]NAt INSPECTION BY: ') ----------------------- Date l_. -` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 ¢M 8-61 AILAS I