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fOR'JFFICE USE: - ' ----------------------------------------- --------------- // JJ Permit No. ----------------- ------------------------- ---- -------- APPLICATION FOR SANITATION PERMIT 1 --------------------------------------------------------- (Complete in Duplicate) Date Issued .__Y/txAy This Permit Expires i 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. ;P&y2C( 2_-� _ C_,c)Le o,,J F I. JOB ADDRESS AAN��,,D�� LOC//A��TION. ____._ClA___ �,,_� :nu-�--L�_� .�_ ��` ______?Y`?`ftDr2.9 Owner's Name_-.Cl�e��-____._•__. .- --.-. Phone------------------------------------ -------------------- Address ' ' �; ----ph--- - IC1 rr � ---_.. ........... ........ `�`R' _ / � ` -------- Contractor's Name__ - p�� I Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms __-i_ Number of baths _fit Lot size ----1_<& {_��___________________________________ Water• Supply: Public system ❑ Community system ❑ Private R1 Depth to Water Table .35-ft. Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X) Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan,] Previous Application Made: (If yes,date____________________) No New Construction: Yes No ❑ FHA/VA: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well--- --------Distance from foundation_..1G`1____.__...Mate ial---C No. of compartments__-__.-2---------------Size___�i� _IL1_k,,�'_�__Liquid depth_-_�__;____-___l�__.Capacity__Afa4? �s Disposal Field: Distance from nearest well__3'_7------Distance from foundation___._KQ_______-Distance to nearest lot line--- __-_--- Number of lines________?___________________ Length of each line--- 47�7 7-Z_.5;-9 P.Width of trench---XD__.-__________.___________ Type of filter material�A__OC _____Depth of filter material____19------------Total length---16.7----__-____________________-4" Seepage Pit: Distance to nearest well---------------------- 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- --- ---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------•---------------- ------------•-------------------------•-----------------------------------------------------------------------------------------------------------•r---------------------------------------------------- ------------- --------------------------------------------•------------------------•------------------------------------------------------------------------------------------------------------------------------------•----------------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------ ---------------------•------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a rows, and les and regulations of the S Joaquin Local Health District. (Signed) - - ` ------ Owner 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). t� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------—T_F ._p`- ------------------ --- ---------------------------------------- DATE--- - REVIEWED BY------------- -------------------------------------------------- ------------------ --__----------------------_ DATE --------------------....------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:-----•---- ----------- ----------------------- ---------------------- ---------------------------------------------------------•------------------------------ --------------•--------------------------------------------------------------------------------------------------------------------------------•--------------------- ------------- --------------------------------------- --------------------------------------------------------- ---- ------------- -- --- -----------------------------------------------------------•---- ------------------------------------------------------------------- FINAL INSPEC B �.. �--- Date----------- ---- - ( - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 31A 3-'63 F.P.CC. 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