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FOR OFFICE USE: ----------------------- --------------------------------- r - APPLICAT14N FOR SANITATION PERMIT Permit No. ../7�G_7�_. ------------------ -------------------------------------- -- -------------- ---- - - ----- - ---------------------- (Complete in Duplicate) --------------------- ----------------------___._-_.--- This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for permit to construct�andrinstall the work herein described. q This application is made i©�mpliance with County Ordinance No. 549. JOB ADDRESS AND DLLO`C+ATION� 2,'/ Xt4Z_ � �• 4 ey -- J ------------- Owner's Name--------C --- t - Phone ------------•- ------------ Address-------------- --------------------------------- - "`_ ---------------------------------------------- Contractor's Name ----------•--•--------••-•----•-•---------------•--------- F ------- Phone------------------------- --------- Installation will serve: Residence.$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms --- Number of baths - --_ Lot size ---- ---------------------------------- Water Supply: Public system ElCommunity system ElPrivate.* Depth to Water Table 6X7 £t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,IM Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No m New Construction: Yes, ] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-�Q-------DistancGe fro foundation Mafierial --------------------------- ] No. of compartments--- -------------.......Size ' " _--______Liquid depth-____ -.____________-__Capacity_��- .- - Disposal Field: Distance from nearest well P--------Distance from foundation/4�-------------Distance to nearest lot lines--------._ Number of lines------3--------------------------Length of each 1--.Width of trench---- -!{-�!-------.--__.---..-- Type of filter material - -------Depth of filter material---_1- french- A, length_-_--X-Y-0---.--___---_-----_.- 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------.------------------- -- -.----.--.-.-. .! ❑ Distance to nearest lot line------------------------------------------------•-----------------•------------------------------------------------------------ fn Remodeling and/or repairing (describe):-------------------------------------- -----------------------------------------------•-----•------------------------------------------------ ---------- ------------------------------------------------------------------------------------------------------------------------------=-------------------------------- -------- --------------------------------------- ----- -----------------------------------------M------------------------------------------------------------------------------M------------------------------------------m ----------------------------------------------------------------•-------------------------------------------------------------------------------------------------------- - -----------•--------------- ------------------- ----------------------------------------------------------------------•-------------•-------------••----------------------------------------------•----------------------------------•---------------- -------- --- ----- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan - ---- 0__ 9 ----------------------------p- ------ ---------------------------------ces, tate aws, an ry es an re u ations o t e an oa uin oca eat istrSiedOwner and/or Contractor 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 APPLICATION- ACCEPTED BY-_/,51905;itrt�- - ---------------------------------------------------------- DATE_?_/14-4/---------------------------------------- REVIEWEDBY-------------------------------------- ------------------------ DATE-------------------------------------------------- BUILDING PERMIT ISSUED------------------------------- ----------- -------------------------------------- ------------------ DATE------------------------------ Alterationsand/or recommendat ions---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- -------------------- --------------------------------------------- ----------------------------------•--------------------------------------------------------------------------------------------- 4 FINALINSPECTION 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 A ES 9 REVISED B-59 3M 3-'63 F.P-CD. 4 J