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FOROFFICE USE: ------- ---------------------------------------------- APPLICATION F`OR SANITATION . ..�RMIT Permit No. ...1_ 1 ---------------------- ------- -------- -------- -- (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 ANyD�O�CATION_- I't-az"-t Owner's Name-------- `' --@_ T;I ,- -�i�- _— p � c --------------------- --------------------------- ------- Phone------------------------------------ Address---------------- 7` tc?- ------- '` --------- -' --------••----- •------------------------ Contractor's Name----------------------- + -------------•---------- ---- ------ Phone ----------------- Installation will serve: Residence y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑] Number of living units. ___. Number of bedrooms __'.t/Number of baths _�. Lot size -___-__/____ _____-__ Water Supply: Public system ❑ Community system Private xDepth to Water Table Akft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date------- ----------I NoNew Construction: Y,e911�1 No ❑ FHA/VA: Yes ❑ No_f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welI100�-DistaricA from foundation__149________-vlaffial____ . ----------------- No. ____.__ ___No. of compartments_..--„-tt-------- -----Size__ K,4'A_A77......Liquid depth _'c- ---t-----Capacify.- ----- Disposal Field: Distance from nearest well__/4�?&”__Distance from foundation. --------Distance to nearest lot line._- (� Number of lines---)�----- -----------------Length of each iine__f ------------- Width of trench___.A__�� Type of filter material - -,Depth of filter material._1 ---------------Total length--_. ------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- '1 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------:..Lining material-___.___.__-._-----.__._____________ ❑ Size: Diameter------------- ----------•------------Depth----------------------------------------------------Liquid Capacity--------------------- gals. ----------------------------Distance from nearest buildin - -- Privy: Distance from nearest well-------------------------------------------------- -building---------- ---------------------- - ❑ Distance to nearest lot line----------------- - Remodeling and/or repairing (describe):----------v-------- ---------`----- --•------------ -�✓ = x 4f� -----------------•-----------------------------------------------------------------------------------------------------------•------------------------------ ---------------------------•------------------------------- - I hereby certify that I ha preparegd this application and that the work will be done in accordance with San Joaquin County ordinance st�5�@te aws ander es and re ul tions of the San Joaquin Local Health District. (Signed) = v� /. --- --- ---------------------- -------------------------- ------(Owner and/or Contractor) ---------------------------- 1; By:----------------------------------------------------------------------- ---------------------------------------------------------(Title)-------------------- -------------- -- --- - ------- (Plot plan, showing size of lot, Iota i n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------- ------------------------------------------------------------------- DATE------------------------- ------------ -------------------- REVIEWED BY / ATE BUILDING PERMIT ISSUED – DATE. Alterations and/or reco mendations:___----------- -------- ----------------- ----------------- - � - - � � f -------------------------------- -- - -- -- ---- --- ---- ---------------------------- -------- ------ -- ----------------------------- ------- ------- --------------- - ------------------------------ ------ -=--- --------------------------------- -------------- ----------- FINAL INSPECTION BY:.. ---------------- ------ --- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazeltan Ave. 300 West Oak Street r e- ..124 Sycamore Street 205 West 9th Street Stockton,California Jodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'S3 r.P.ua.