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FOR OFFICE USE: �f\06 Icy, ----------------------------------------------- --------- - __.___-_______. APPLICATION FOR SANITATION PERMIT Permit No. --------------- ----------------- . 7.9 ------------------------------------------ -------------- (Complete in Duplicate)This Permit Expires 1 Year From Date Issued b Date Issued ..7�/..��- 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------� � --------------------_._. _f .......................................------- Owner's Name----- = - ------- ,tone, �i Address-- .---.-------•..Z .---•--. Contractor's Name----------_-------- .... ---------------------------------------------------------------------------- Phone--------- Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I___ Number of bedrooms ----!... Number of baths ___-(___ Lot size .___ 7/___n..�b O Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _�_—_ }t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No\] New Construction: Yes'K No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well__��.n_._ Distanfrt frc�6foundation._...�_ _-__-_.Mater'al_ __ __-____. No. of compartments-- Si ___!_____--X. S__Liquid de t ..__.. _ Ca acit ------------------ 1Z -�®o p .�' ......--- q R P y...-------.�------ d Disposal Field: Distance from nearest ell._��©_�"Distance from foundation___ .._Distance to nearest lot Iine__�.......... Number of lines--------r:.. Length of each line � �f�_� filth of trench.__a�__,_____..__._____._... Type of filter material--------- _Depth of filter material...L�-______________Total length....... ...............•_____--__---__. 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------------------------------------------- F-1 _____ __-__.--- ._ -----.❑ Distance to nearest lot line--------- ----------------------------------------------•-------•---•----------------------------•------•--------------.-------------------- Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------- ----------------------------------------------------------------••------••------•---•••-------•--------•----------•------------•---------------------------------------------------•---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- r 1 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. ,C (Signed) = 4Z------------- ---- -- - ------------ (Owner and/or Contractor)s BY: •---- ---------- -- - (Title)--------------------------------------------- ---------------- (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---- -- REVIEWED BY-------------------------------------------- •- ,f= DATE---- BUILDINGPERMIT ISSUED-----------------------------------------------1 DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------- ----------------------------------------•-------------------------•-----------------•--------------•-------•.......------------ ------------------------------------------------------------------------- -----------------------------------------------------------------------------•-------------------•----------------------............... -------------------------------------------------- --------------------------------------------------------------------------------------------•-•--•--•-------••----------------------------------------------------------- ------------------- ------------ ------- -- ------------------------------------------------------------------------------------------------------------------.------------------------- ----------------------- -------------- - FINAL INSPECTION BY:------'--------_��----------------�-------------. Date.---------- --------r------------------- 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 B-59 3M 3-'63 F.P.CO.