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FOR OF lZUSE: ��_�3 y---------�---- r ------------ tr APPLICATION FOR SANITATION PERMIT Permit ----------------------------- - -- - (Complete in Duplicate) O ` f -.l --•t�3 ------------------------------------------_______________ I This Permit Expires 1 Year From Date Issued 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 Orydin No. 549. J08 ADDRESS AND LOC TIO :,vim _ __C.._ �_16_ _ - -------------------------------------------------------------------------------- Owner's Name---- t'------ --- ------•----••--•------•--------------------------- -----•----------------- ------ Phone--------------------_-------_---- Address 'z -- - - ---------- Contractor's Name----------•--- -- - '�? ---------------------------------- ------•------------------------ Phone------------------------ Installation will serve: Residence [;_A`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.1___ Number of bedrooms _ _ Number of baths __1---- Lot size __a..t` x _�_ __�______________________________ Water Supply: Public system t__�Community system ❑ Private ❑ Depth to Water Table -4i;? 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 New Construction: Yes �o ❑ FHA/VA: Yes ❑ No Q� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Teak: Distance from nearest well___ ------Distance from foundation__-1Q--------___.Material---- ___ ____________ _________________ No. of compartments____;;�z_...........____Size__-3_K_4 -9---------- depth------ I----------------Capacity..._,?�I�i� Disposal Field: Distance from nearest well--------—Distance from foundation-JO............Distance to nearest lot lineA../__-_____ Number of lines------/-------------------------Length of each line--- �- -----------Width of trench--- ------------------------ e of filter material 7m_� __.___..___Depth of filter materiall$__e______________Total length___-.�d._�-_.---___________________ v f. a._ 1J . Seepage Pit: Distance to nearest well.. R"-.__-__-_Distance om foundation__!e__�__.__..Distance to nearest lot line_':�_�_____ ❑� Number of pits____-______----------Lining material_____ ___C?G ___..Size: Diameter_--{?c ----Depth-------020 ._-_______ ------ � Cesspool: Distance from nearest well-----------------Distance from foundation__------------------Lining material__________________.__________-__._--. `1'1 11 Size: Diameter-------- ------Depth----------------------------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well---------------------------------------------_:_Distance from nearest building----------------------.-----------.----._. ❑ Distance to nearest lot line------------------------------------------------------------•-•------ •---------------------------------------------•----------------------- Remodeling and/or repairing (describe):---------------'__._. -__ - Q 11. 11 --------------------------------------------------------------------------------------------•-..-...------------------------------------------------------------------------------------------------------------ --------- 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 regulatio s of the an Joaquin Local Health District. (Signed)-----------:---------------------------------- ---- -------------- ---------------------------------------------------------------------------------(Owner and/or Contractor) ey:.. •------- ------------- - - -- - - ------ -- ----------------------------------------------------------(Title)------------------- --------- ------ -- - -- - ------- (Plot plan, showing size o ocat f system in elation to wells, buildings, etc., can be placed on reverse side). �r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------L-_._- 7-14t�---------------------=------ ------------------- DATE--- - ---------------- ------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE---------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DA•TE----------------------------------- Alterations and/or recommenafi ns: --------- -- -------------------- --- . 1---- ' 3 --- ----- �-r ar '� ------ -------------------- --------------------------------------- - -• - �� 0410%_rt-0__ Gly^^- ---------- ---------------------- -------------------A7------------ - mm ---------------------------------- -------------------------------------------------------------------------------- -------------------- -- ----- FINAL INSPECTION BY:- C -_--0-r- --------- ----- ------- Date__----A0_ 7—.4-_ ---------- ---------------------------- 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 E6 9 REVISED 8-59 3M 3-'63 F.P.CD. 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