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FOR OFFICE.USE: aDa($ ;) -rMbT • qZ0 --------------------------------------------------------- ____.______.._.._.__.-_______________________________ APPLICATION FOR SANITATION PERMIT Permit No. .14. __. ..� --------------------------------- ------- (Complete in Duplicate) //6 ___..___________________ ----------------------------- This Permit Expires 1 Year From Date Issued _______!_.._ Date Issued --- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---4..D t.. / 'v = -I,--,---"--,` ---- ----------------------- ----------------- f ---•--••-•---------- Owner's Name ..�..-- ---------- -----------------------•----------------- Phone.................................... ---- 7 1A Address------------ fir t -' ,�L�c�:-'------- �` ----------------------------................... - 7 Contractor's Name............. ``�:.+G .. .t...�C==�:L------------------------f------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other Number of living units: ---I--- Number of bedrooms ----1--- Number of baths ---- Lot size -____________________ Water Supply: Public system ❑ Community system [X Private ❑ Depth to Water Table J 6 ft. -- Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam F] Clay Loam E] Clay 0 Adobe[-] Hardpan C]Previous Application Made: (If yes,date.-___.__-.-._..__..1 No New Construction: Yes 0, No ❑ FHA/VA: Yes ❑ No J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , , y Septic Tank: Distance from nearest well___3 .Dista e from foundation__,�D__-----------Material_.._f` _�� _.__-----__. No. of compartments__�.__________________Size_rX..X.K..4 .....Liquid depth..... -----capacity..-8-�_d-' ........ p Disposal Field: Distance from nearest well_15Z�--_Distance from foundation_..... -__.Distance to nearest lot line��. �. r® Number of lines______________ __._._______-Length of each line___-____. �_____ Width of trench---..�:_ _.__....___.______ L/---- Type of filter material...$. .2 '- __Depth of filter material___----1Y---------Total length-------gQ........................... Seepage Pit: Distance to nearest well----------------------Distance from foundation-------.............Distance to nearest lot line......_.......... ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------.----Depth____-___.__._._---------_-__-_-_ s O 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--------------------.--------------------- 171 --___-__._ ___-.-.❑ Distance to nearest lot line--------- ----------------------------------------------•-----------•----------------------------------•------- --------------------------- ez Remode g n or repairing (describe)--------------------------------------- ------------ -- ----------•--- --�'--.-�'-5 ---- �` ----------- ------ . -- ------------- �-------------------------------•------------ - -------------- -- ___._____._.F ________________________i_____..........____.______ .__...--_---..-_---•_---_.__----_____._.•.___._._______.__..__-_--__-__---- ��"-�..1�. -��,'\��C�:c�--__-_----___-. . 1 -------- -- 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. 1 OOV � � y `�, - i --v------e-= - 0 (Owner and/or Contractor) - By:-------------------------------------------------------------------------- -7---------- ---------------------------------------(rtle)---------------------------------------- -------- ------------- (Plot ------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). V FOR DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY------------------------------------------------------------------------------------------------- DATE..........................--------------------------------- REVIEWEDBY------ --------------------------------------------------------------- ----- - DATE--/2- - �, �------------------------- r BUILDING PERMIT ISSUED------------------------------------------------------------ DATE ` --- - --------------------- Alterationsand/or recommendations:------------------------------....................................-----------•--•---•---•-------•--------.•...-----------------•----•-•. .----------------- ....--•-. ------------------ ---- . . . -------------------------------------------•---------•------•---•--•--------•------------------------------------------•-------••-- ----------------------------------- ---------------------------------------------------------------------- ............................................................ ------------..... ---------------- .........................------ - ----------------------------------------------------------------------------------------------....•-- ---- ----- ------------ ------ •---•-.._... ---------------------------------------------------- -----------------------------••-------•--- FINAL INSPECTION BY: - =--- -- ---------- Date-------------------1........ Y,'_ 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 ES 9 REVISED S-59 3M 3-'63 F.P.CD. -