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FOR OFFICE USE: 6 0-7 -t APPLICATION FOR SANITATION PERMIT Permit No. ..• ......... -------------------------------------------- (Complete in Duplicate) Date Issued _____________________________ _________________________ This Permit Expires 1 Year From Date Issued ____ 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 ' �;: ` "` == /C,t�c - w-.---C� 2%�'-------.-•---------------- Phon Owner's Name ----•------•------------ ----- --- --------- , { � � ------------------- Address � �� -Contractor's Name.............................................................................................................................................. Phone.............................. Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J-___ Number of bedrooms ____/__ Number of baths ----I__ Lot size ---- ._ (_ ________________________ Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table _18 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay N Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------______--------) No1�f New Construction: Yes No ❑ FHA/VA: Yes [I Nol ] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' ��^BJ f_ foundation_-__��_.___.___. Tank: Distance from nearest well_ _-Distant r B ----------------------------------- 91 No. of compartments__�-----------------Size.... Liquid depth------- _-- Y____-Capacity_._.VV__�..___ _ Disposal Field: Distance from nearest well__�� _Distance from foundation_.__U.._.__._.Distance to nearest lot line.__J----------- !r Number of lines------, Length of each lines�q_--3O_7_3'o_-Width of trench__.:_ ___--------- ------ ______ Type of filter materia -------Depth of filter materlalA—_______-_____Total length______�_U____________________________ C� 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------------------------- ---------------------------------------- ------------------------------------------------••---•---------------- Remodeling and/or repairing (describe):---------------------- -----•----------------------------------------------------•------------------------------------------------------ ------ -------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------- ---------------------------------------------- ---•--•------------------------------------------------------------------------------------------------------------------------------------------------------•------- _______ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State law , and rules and regulations of the San Joaquin Local Health District. J (Signed)--•�-_ ---- = :Z' `--------- ---------------------------------------------------•-------------(Owner and/or Contractor)114 ----- - -----------------------------------------------------------------------------------------------------------------(Title)---------- ----------------------------_--- ------ (Plot - --(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 APPLICATIONACCEPTED BY--------- ----------------- -------------------•- ------------------------------------------- DATE..............................--------------------------- REVIEWEDBY----------------------------------------------------------------- ---- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED DATE. ------------ Alterations d/or recgmnlendationk: -7L.., - .........) --------------------------------------- - - FINAL INSPECTION BY:- -------------------------------------------------- ---------- Date---- !!` 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 B-59 3M 3-'63 F.P.CD.