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FOR OFFICE USE. --------------------------------------------------------- APPLICATION FOR SANITATION No .� ------------ ------------------ --------------- -- (Complete in Duplicate) � "= ________.__________.-_______________________ This Permit Expires 1 Year From Date Issued Date Issued ... j Application is hereby made to 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._ n , U --- - l _____ ______________ - Owner's Name----- ..... S .' ................................... -------------------------------------•--------------------•--- Phone.................................... Address L-1 -.........f_.. Contractor's Name 04 � al' 4 - Phone Installation will serve: Residence Q6 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms ----I Number of baths ---/--- Lot size ___4.c---__�/__A...fDQ---------------------- Water Supply: Public system ❑ Community system a Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay IM Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No a New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) VN Septic Tank: Distance from nearest well_________________Distanc from found tion__/d - .�._....__.Material-_.___�P1G1 G1C°f 7__._____--__-•. (� No. of compartments__-___-�________________Size.....P��._X-_ z Liquid depth__... z________Capacity..._.f_1�_>_"2°� , Disposal Field: Distance from nearest well------ Distance from foundation....1'0_/-------Distance to nearest lot line.... ............. '0 WT Number of lines------------.,/--------------------Length of each line-----e -----------------Width of trench.-_�______cam-4/_._________-__ w, Type of filter material.._St__l _ -_Depth of filter material.__-..14_ ____..Total length._______.Jr�_ _______________________ 1 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------------------------------------------ 11 Distance to nearest lot line-----------------------------------------------------------------------......------•----------------•-------------- •---------------------- Remodeling and/or repairing (describe):-------------------------__............................................................................... 1 --------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- 1 ---- ------ N I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County` , ordinances, Stat la s, rules and regulations of the San Joaquin Local Health District. !/�/ (Signed) --- ••--- -- -- -- ----------- --- ------------------------------........................ .(Owner and/or Contractor) By:--------------------------------------------------------•--------------------------------------------------------------------------(Title)--------------------------------------------- "--"--- --------- (--7 (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 d APPLICATION ACCEPTED BY-------CJY--.WWQ-- ------------------------------------•-------- DATE--�---=--R--- �,------------------------------ REVIEWEDBY---------------------------------------------------------------•---------------------------------------------------- --------• DATE---------- ---------•-------------------------------------- BUILDINGPERMIT ISSUED-----------------------•-----------------------------------------------------------------......... DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------- -------------------------------------------------•-------•--------------•--•-------•----------......------------------------------. --------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------- -------------------------------------------------------------------------- -------------------•----------------•--------------------------- - - -- ---------------- ----------------------------------------------- -------------------------- ----------------------------------------------------------------------------------------------------------------- -------- ------------------ -----\--.---_-- •----- ------------------------------------------------------------------------ ------- ------------------------•- FINAL INSPECTION BY:--- X Cwt? Date. (Y <Q `�^ 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 96 9 REVISED 8-59 3M 3-'63 F.P.CD.