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FOR OFFICE USE: �' - --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... - ----------/ ---------------:�---- ---------- (Complete in Duplicate)� Date issued .------------ --�a� _----- ------------- This Permit Expires 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. .i06—AE&ESS ANAOCi°,TION_ .�'�^ ---- -- -- Owner's Name------- - Phone-----•--------------------------•--- ------------------------ Address-------•-----------------#�-r--0------•-----� - ---- �-F--� --•--------------- ---�----- --- -- �------------- -- - --------------------------- Contractor's Name--- ___-- _ �- - ..__� tv Phone--------------------------------- t- Installation will serve: Residce ❑ Apartment House ❑ Commercials] Trailer Court ❑ Motel ❑ Other ❑ d 634' �J"m Number of living units: -------- Number of bedrooms -------- Number of baths _j----- Lot si a ___ __ _f�___ -•----••-------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _l.fl__ ft. Character of soil to a depth of' 3 feet: Sand ❑ Gravel ❑ Sandy Loam 20 Clay Loam ❑ Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: Ilf yes,date--------- ----------) No El New Construction: Yes E] 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-A.1--------Distance fr m foundation---/Q-----------.Material____ ----------------------------------------- (�] No. of compartments---- -------------------Size'y_ + --_ r/z---------------Liquid depth--- ---------- Y. Capacity��--------- Disposal Field: Distance from nearest well479-f----__Distance from foundation__-%=D------------Distance to nearest lot line__+......... Number of lines--------- ___ ----/- Length of each line------/---------------- Width of trench__,'-_y------- 'jam Type of filter m, Depthof filter material-At-------------Total length--A-`D--------------------- l 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-------------------------------------- '� f ❑ Size: Diameter--------------------------------------Depth_----------�--- -------------------------- Liquid Capacity gals. _--,Distance from nearest building i Privy: Distance from nearest well---------------------------------------- = ❑ Distance to nearest lot line-------------------------- --- ------------•------- ------------- Remodeling and/or repairing (describe):---------•--------------------------------------------------------------------------------------------------------------------------- ------------------ ----- -----------------------------------------------------------------------------------•---------------------------------------------•-------------------------------------------------------------------------------- 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 t -___. Owner and/or Contractor t t [Signed) .C ,�--------�-�/O�ch�---- -=---- ----- ---------------- - - _ ---- - ------------------'----------------------------------------- (Title)------------------- -------------------- ------------ ----- r (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY ___ - -------------- -----------------'=---------- bATE�t _'_L` - REVIEWEDBY ----------------- DATE-------- --------------------------------- ---------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------- -- DATE------------------------------------------------------------- Alterations and/or recommendations------- --------------------------------------- -------•---------------•----------------•-----•-•----•----------------------------------------•-------- ------------------------------------------- --------- -------------------•------------------------------------------------ - -------------------------------------- -------------------------- -- ----------------- ------------------- -------------- ------------------------------------------------------------------ - -------------------------- --------- FINAL INSPECTION BY:. r �t�-- � � ------------ - � Date------------ ------ -`-�-- ------ ------ ------------- ( SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED B-59 3M 3-'63 F.P.CD. -