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FOR OFFICE USE: ----------------------------------------------- ZM APPLICATION FOR SANITATION PERMIT Permit No. --,/ ................... --------------------------------------------------------- ----------- ------------------------- (Complete in,Duplicate) —Date'lssued ----------------- - ------------------------------------ This Permit Expires I 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 complianc�6 with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-- ..... .. ---------------------- -- ------- ---------------------------------------------------------------------------- ---------------- Owner's Name----- ------��.:57, 05 ------- ...... --------------------------------------- -------------- .Phone---------.:--- ---------------------- le- Addr cez ess-------------------------- ----------------------------------------------------------- ......................................... ---------........ ---------—--------------------------------------------------------- Phone.---------------- ------- Contractor's Name.. 4----------S�_ t Installation will serve: Res1clence Apartment House Cj Commercial E] Trailer Court [:] Motel 0 Other El Number of living units:---I---/--- Number of bedrooms Number of baths ---- Lot size ---,. , Water Supply; Publictsystem Ej❑ Community system E] Privale �[D—epfh to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam 0 Clay ❑ Adobe E] Hardpan E] Previous Application Made: (If yes,date--------------------) No 1K New Construction: Yes No 0 FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool peirniffed if public sewer is available within 200-Mol Septic Tank: Distance from nearest well4� from foundation--- -----------M aj`e7- �� ---------------*----------------- No. of compartments--------2 ------------ Liquid depth__--_- Capacity....K49-n------ Disposal Field: Distance from nearest well-tTo-------Distance from foundation----1 -1-------------Distance to nearest lot line---t;;�� Number of ------------------- ------Length of each line--jQ---t------�4__ Width of french_.__�7�_VJl ------------------- Type of filter material-, ---Depth of filter --- .-.Tyz5�_ � material___:-_!_�----- =---Total- length--------7-e:?--_4--------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------- ------Distance to nearest lot line-_.____________ ❑ ine----------------- E1 Number of pits----------------------Lining material---------------------:.Size: 'Diameter-----------------------Depth------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------.1ining material_____--..--__.._--.._._--' P ---------- 0 ❑ Size: Diameter---- Depth -------------------------------- ---------- ---------------- --------------------Liquid Capacity---.------------------------gals. F�rnw—y —____ D"istlancelr—=_"n 'arest —we-11 --- --------------------------------------------Distance,from nearest building--:----.----_-__---------____--- .- ---_.. ❑ Distance uilding------------------------------------ Distanceto nearest lot line------------------------------------------------ ---------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------- ----------------------------------------------------------------------------------------------------------------------- ........................I.......I----------I--------------------I------------------------------------------------------------------------------------------------------------------------------------------:---------:---- ---- ----------------------------------------------------------- ----------- ------------ ---------------------------------------------------7----------------•----------------------------------------------------------------------------------------------------------------r---------------------------------------------------------------------------7------ �----------- I ---------- 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. ------- --------- ----------------------------- ----------------------------------------------------------I-- - -----(Owner and/or Contractor) 0 Bycr -- -- ------- - _41v -------------------------------------------------------------------(Title)------------------ --------------------------------------------- (Plot plan, showing ize of,lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- t -------------------_---------------- -------------- --- DATE DATE--------------k------ ------------------------------------------------------------- - REVIEWED BY-- --- ------------------___------------------------ - ---- -- BUILDING PERMIT ISSUED-------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recor�"enclations:__.------------------------------------------------------------------------------------------------------------------------------------------------------------- f ------------ --------------- ------------------------------ --------- ----------------------------------------------------------------------------------------------------------- ...... ---------------- ---------- ------------------------ ...... -=------------------------------------------------------------------------------------------------------------------------------------ -------- ---------------------------- ------------------------------- --------------- ------ ---------------------------- ----------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------ --------------- L --- ------- -- ---------------------------- FINAL INSP`ECTION BY:. - ---------------------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan 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.120.