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FOR OFFICE USE: ---------------------------------------------- ._.._-____.___.._____.__.__--_____________________- APPLICATION •-FOR •SANITATION PERMIT Permit No. ----------------------------------------- ------------- (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 a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA ION -------------- ------------------------ --------------------------•------------ Owner's Name1 Phone AddressI.1.. ju -per"' t ----------------------------,`•---------------------------- -------------------------------........ Contractor's Name------------ Mi6M..�-©- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: _-1____ Number of bedrooms -9- Number of baths _____Z Lot size --------J,/�_�_______________________________" Water Supply: Public system ❑ Community system [?"Private ❑ Depth to Water Table ZP__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe B--�Hardpan ❑ Previous Application Made: {If yes,date____________________) No ❑ 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 Distance from foundationIb___-.___.Material-______ ?G '-�/ ®� No. of compartments_.___-__ Size----� _X__ .---Liquid d � epth_-.______ VCapacity_____- . Disposal Field: Distance from nearest well__....Distance from foundation__/?-----------Distance to nearest lot line----- `-__- [� Number of lines________ _ --�-.�____ Length of each line--------&S -------------Width of french-------`c�___ ______________.___- Type of filter material_ _K -Depth of filter material-__--1_E4_ --_.___.Total length-----------Z4-0--____ ------------- 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 buildi'n4-- ------------------------------------ 0 Distance to nearest lot line... Remodelingand/or repairing (describe):--------------------- ----------------------•--------- •----------------•---------•---------------•----------••---------------------------------------_. -----------------"-----------------------------•----------------•------------------------------•----------"------------------- ------------- ------------------------------------------------------------------� x- 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. (Signed)-/-_ _____________(Owner and/or Contractor) Y:-------•-----------••---•------------•-•--------•- --------------- ---------- ------------------------ -•-----------------------(Title)-- ------------------------�-�--�-�-.......... .......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART NT USE ONLY APPLICATION ACCEPTEr= _'------------- -------------------------------------------- DATE---- -f �� REVIEWEDBY------------ ----------------------------------------------------------------------------------- DATE-------------------------------- BUILDINGPERMIT ISS ------------------------------------------------------------------------------- DA•TE------------------------------------------------------•-- Alterations and/or reco -------------------------------------------------------- FINAL 1NSPECTIO :._ ". :...._ --"----- Date--------.t��-47 - ------ - - --- - - - JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California }^may Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3••63 F.P.CO.