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FO OFFICE USE: - ' `- '4 f-----------------� �' -- " � . ---"_______________ - APPLICATION FOR SANITATION PERMIT Permit No. .1,7Q.1 -----_-, -- (Complete in Duplicate) 1 - - Date Issued ...-•--•-- --------------------------------------------------------- 4 This Permit Expires 1 Year From Date Issued 1 1° 3 -3o0-10 Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 'This application is made in compliance with County Ordinance No. 549. / r/1 -- ------- -------------- _ - `/-�q -r------_ ____.__.�..... .... ------- ---------- ....' - J/OB ADDRESS A D OC 0 _ ___ ____ ___________________ __ _ (! T. Owner's Name ..._ --- - ------------------------------------••----------- -----------•------ ----------- -- ----- Phone-----•-- Address------------_------------------------ -- --------------------- --- --- I...--------- ---------•................-------•------•---•--•---.-..---------------------------------=--- Contractor's Name----- ... -------------- ----------- ----------------------------------------•-----_-------. Phone---------------•------------------- Installation will serve: Residence 09�partment House ❑ Commercial ❑ i Trailer Court Motel ❑ Other ❑ Number of living units. -t----- Number of bedrooms 3_- Number of baths __�._.. Lot size' -�x- - ---------------------------- F r; Water Supply: Public system ❑ Community system ❑ Private RR' to Water Table Characfer of soil to a depth' of 3 feet: Sand Gravel ❑ - Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made (If yes,dafe--------------------) 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 200 feet.) Septic n istance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------:_---__--. No, of compartments-------7---------------------Size---------------------------------Liquid depth--------------------------Capacity----------------------- Disp I F' Distance from nearest well.e I-----Distance from foundation_« _ ........- -.Distance to nearest lot line__-�-__--------- c f � A Numbers of lines ----------------- -------Length of each Iine---�aZ�. Width of trench wt y ---•-- Rr�� Type of,,filter materiar__/TQ.(___�t------Depth of filter material/_-$----------------Total length----*fid_!-------------------------- 11' Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------_----:. L4 ❑ Number of pits----------------------Lining mater'�ial------------------`-__.Size: Diameter------------------------Depth---------.----------------------. �1 . Cesspool: Distance from nearest well-----------------Distance from foundation-_.._--------------Lining material .----_..-.--.-_------._-__--__--_ p ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity- -------------------------gals. �r Privy: _ .Distance from nearest well --------------------------------------- ._.____Distance from nearest building------.---_--__-----__---__------.------. ❑ Distance to nearest lot line--------------------------------------I Remodeling and repairing (describe):-_ ,.._______` C1- _ 1'` , - ------------------------------------ ---------------------------------- --------------------------------- '°---------------------------------------------------------------------- hereby certify that I have prepared this applicationkwells, work will 6e done in accordance with San Joaquin County ordinances, State laws, and'rules and regulations of the Scal Health -District.. (Sign d)---�"'--`-"-- -----------------------------------------------------(Owner and/or Contractor) ----------------------------------'------ --- -----------------••••--------=----------- - -------------------- :---(Title)------ ------ ----- ---------- --------- ------ ------- (Plot Ian, showing size of lot, location of sysfe tionowes,• ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------- -------- ------ ----- ------- ------------------------------- DATE-------------- /f REVIEWED BY---------------------------- - - - DATE----- - BUILDING Alter t ons and/orTrecommD dat' ns-------------- ------- DATE-----------.- . _ ^' ' "�f ----- isfactor-Y- ---------------------------------------- --- ' conn c# on-.fico--drai.nfield unsatisfa_at�Qry- J.D.- FIN L INSPECTION BY:----------------' -- ---- `-s----- --------------------- Date--'-'-.. 6 L,L SAN JOAQUIN LOCAL 1EALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5111cktonr California Lodi,California Manteca,California Tracy,California ES REVISED 6-59 3M 3-'S3 F,P.CO. j m •w -' si.�