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FOR OFFICE USE: l l ------------------_-------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__1-- ....... • f (Complete in Duplicate} pate issued /1.3—5' _----------------_-----_ This Permit Expires 1 Year From Date Issued i 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. - .� ( --� I JOB ADDRESS AND LOCATIO ;��-_------v__� ---------- -------- ` !!c - ---------Phone---------------------- Owner s'Nam '' '' ------- -2 ----f r' ---•----------------------------•--•------ ---- Address -..t-L-�. --- i Contracfor's Name__.-------�5l1---- -----------•------- Phone......................#----=-------- Installation will serve: Residence M( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 hlumlier.of living units: _�___._ Number of bedrooms .�-- Number of baths _t.__-. Lot size ._________ /Gyle ' Depth to Water Table ._______ ft. J Water Supply: Public system El Community system [I Private [ Dep ! 1 Character of soil to a depth of 3 feet: ' Sand E] Gravel E] Sandy Loam ❑. Clay Loam [cClay E] Adobe❑ Hardpan 11RF Previous Application Made: (If yes,date____________________) No E] New Construction: Yes E] No E] FHA/VA: Yes [Io-. I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)i a Septic Tank: Distance from nearesf well_____�r":G Distance from foundation_____,f�'_______.Materiai_----4?.7"7 ------------ I No. of compartments--------�---------!-_Size_A/!.�� ,��' -_ - - _Liquid depth--------------Capacity._f...� ' Disposal Field: Dis+ante from nearest well--�e-/ .Distance from foundation___ ,/E'_`.__-- Distance to nearest lot liner`.________ Len' th of each line______ 0--/_--._____�Widfh of trench---�L-/.______..__..__ F9 Number of lines------ r: R Length ^ F/ f .,. Type of filter material____.__ - --__Qepth of filter material____.,f-____.___..Total length_ ___:________________________ y. Seepage Pit: Distance to nearest weld__________ __________Distance from foundation____._______----__lDistance to nearest lot line----- Number of pits----------------------Lining material---:------------1-----Size: Diameter.-.- Depth � . � , i -Cesspool: Distance from nearest well___ ___________Distance from foundation--------------------- material_____ '_______-__________;_____..___. ;Li'Liquid Ca acit -j ___gals. :❑ Size: Diameter------ -------------------)--------- Depth-----------------€-- -------------- - q P y--=-------------------- 9 7 p Privy: Distance fromrnearest well___-_-'-______-___-- 'r'- ` --Distance from nearest building--- .___--_________________________..___ fi r [l Distance to nearest lot line------------------ ------------------------- ----------------------------i------------------------------------ ------------ ------- Remodelingand/or repairing (describe)=-------------- -----------------------------------------------------•---•-•-------------------------••-•--------- `-------------------------------- 1 .l - ----------------------------------- - --------------------------------------- ---------------------------------------------------- -----------=---------- T 1.. ------------------------------------------•--------------•-----------'-- ----- -------------------------------- i --`=-�------------------------------------------------------------------ ,�? 1 hereby certify that I have prepared this application and t6iiPthe work-work done in accordance with San Joaquin County ordinances, State laws, and rules and'reguatiio`ns of +he-San Joaquin Local Health District. �(Signed) --- ,� ----A•--------- --- ----- - -------------------- ------------------- - ------------------ -- (Owner and/or Contractor) Plot lay, showing size of lot; location of system � W buildings,s (Title)--------------------------•-------------------- - ------------- ( p -_ g in relation o wells, buildings, etc., can be placed on reverse side). -- FOR DEPARTMENT USE ONLY CAPPLICATION ACCEPTED BY---- --------------- -- -------------------- -------------•---- DATE- 2 —--- ----------------------•------ IREVIEWED BY---------------------------------------------------- ------------- -------------------------------------------------------- DATE----------------------------•------------------------------ BUILDING PERMIT ISSUED-------------- ------- ----------- ------•------------------------------------- DATE 4 Alterations and/or recommendations:-•-------- ------- ----------------- ------- --------------------------------------------------------•-------•--•--•------------.--------------.....---------- -----------------------------------------------------------------------------------------------------------------------------------------i -- --------------------------------------------------•--------------------------------------------------- I , - ------------------------------------------------ `----------------------------------------------�-/------- ------- ------------------ --------------•-- Date---- ---`f"r'tp-��----•------------ -------- FINAL INSPECTION BY 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 19-59 3M 3•'63 F.P.CD.