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FOR OFFICE USE: • --------------------='-------------------------- --- - f --------- - --------------- ----------- ----------•--- l APPLICATION FOR SANITATION PERMIT Permit No. ._.! - •••.• (Complete in Duplicate) �1 Date Issued _________________---- ------------------------------------_____.__-_-_____"_. This Permit Ex ires 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. Df� ( — � '3m: � --------•-------- Ji B ,ADDRESS AND LOCATION_ M j_ e-- � --. � `� Owner's Name----7 � 7_ cr-------------------------- Phone. Address-------7Z!�.�______ ----- ---- ---------------------------••---------------------------•----------- --------•-----•-•--------------------- - r Contractor's Name--.----- P ----"' i 4.)?,------------------- ---•----- Phone.--------------------------------- Installation will serve: Residence Cg--Apartment House ❑ Commercial ❑ Trailer Court ❑ "'Motel ❑ Other ❑ Number of living units: Number of bedrooms _2_ Number of baths 1------ Lot size ....6sxQQ-$• ---------------...._ -------•-- Water Supply: Public system ❑ Community system JI-IF—rivate ❑ Depth to Water Table Y_0__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date----- No [D`—New Construction: Yes � No ❑ FHA/VA: Yes ❑ No IBJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) —.�.rSep#ic�.Tank: -; Distance from-neatest welk:l =Distance=from'foundation _ -: .Ivlateria6_-___________________________ _a=-= ~ ❑� No. of compartments-.----x---------------size----.•--- - _�� --Liquid depth-------31-.--r-----_------Capacity----2'p__ Disposal Field: Distance from nearest well_ _..._.Distance from foundation___- .-.Distance to nearest lot line_ 3-----________ Number of lines---------off----------------------Length of each line----- q- ----------------Width of trench _2 4,- _--------• ;- 6— Type of filter material::77X4�-.______Depth of filter material ___1,V"___-----------Total length__-_-__+f,� ________,✓�x0___.__.- r, Seepage Pit: Distance to nearest well----------------------Distance from-foundation--------------------Distance to nearest-lot line__-______.-__..`I� ❑ Number'of pits----------------------Lining material------------------------Size: Diameter-----------------------.Depth----------------------•---------- { ' Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material___________________----____.____--.__. m ❑ Size: Diameter--------------------------------------Depth-------------------:- --------------- - ---Liquid Capacity-------_------------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-______.___-----_________-_---_----------- -------------- -----------------•------------------------------------- --------------------------------------- 'fa ------------ --------------------- t Distance to nearest lot line___________________ _____ .--_ SLB�`� / ----------------------------------------------------------- ---- Remodeling and/or repairing (describe): `a�� F' •--- ----�--- ---- T ----- ------ --- -- ---- -- ----- ----------•--- •-------------------------------•----------•--•----------------------•----------------------------•------------------------------------- -- I hereby certify tat have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State law , an rule and regulations of +he San Joaquin Local Health District. i (Signed) ----------------------------------------------------------------------------------------------------{Owner and/or Contractor} By:----------------- = --------- -------- --------------------------------------•-------------------------------------------(Title)---------------------------------------- --------------------- (Plo+_plla;,.showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_!_f F ---------------------------------------------------------------- DATE-.2L `_ -;-f----------------------------------- REVIEWEDBY------------------------------------------ - ----------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- T Alterationsand/or recommendations---------------------------------------------------------------------------------- •---------------• ----------•-----••------•--------------------------••------ --------- -------------•-•------------------------------------------------------------------------------------------------ ------------------- ----------•------- ------- ------ -----------•------------ ------>----------- ----- ----------------•-------------------I- -------------------- ------- ------------------------------•------------•----------------•-------- --------------------------•---- ---------------•------------------- FINAL INSPECTION BDate------ - A ---------�----------------------------------------- ------ ----- ------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT F f 130 South American Street 300 West Oak Street tk 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 �4EVI6EO 8-59 P.P.0 O.3m E.-6D ��