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FOR OFFICE USE: ----- -- -- --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___C d!_d__-........ -------------------------------------------------------------- (Complete in Duplicate) !� Y Date Issued 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. JOB ADDRESS�MD LO T10N �_/ VdG --_..___ A-_--� �� _ _±_ _ _--. Owner's Name _ __` --------------- •- •-••--------------- --- Phone------------------------------ Address._.... ... ��y0(� f Contractor's Name----- o J r 7 / -•- -------------- ------ Phone........................---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: _/___ Number of bedrooms,,,-_ Number baths _/__ Lot size ----- ____ Water Supply: Public system E] Community system El Private pth to Water Table _ _____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑rt Adobe❑ 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 foundation___--------______-_.Material-----______._________________________.__________- ❑ No. of compartments------ -------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- DisposO Field: Distance from nearest well 4-___-_Distance from foundation----,/_Q---_....:bistance to nearest lot lime___�________ 16 Number of lines ---------l_______ — Length of each line---------/VG'-------Width of french,------- . Type of filter material___-- -r______Depth of filter material-------/IF_ „rTotal length---------- ------------- Seepage Pit: Distance to nearest well_-------------------Distance from foundation--------____--------Distance to nearest lot line__.__-_________-_ ❑ Number of pits----------------------Lining material.----------------------Size: Diameter------------------____Depth_--__-__--_---_----_____--------- 4 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material_____-------------------------------- ❑ Size: Diameter--------------------------------------Depth------- ----------------------- y Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well--------------------------_-------------_--------Distance from nearest building_____.________________________-__--___--_. ❑ Distance to nearest lot line----- --------------------------------------------------------------------------------------•-------------- --------------------------------- Remodeling and/or repairing (describe):------- ------------------A-------------•---•----------•-----------•-----•-- �Y( r ----------- ......••_----------------------------------------- ------- --------------------------------------------------- --------------------------------------------------------- p --------------------------------------------------------------------------------------•---------------------------- ----------------------------------------- ------------- -------------------------- -------------------------------------M_----------------------M----------------------------------M-------------------------------------------------M--------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County lb ordinances, Sfafrifws, and rules and regulations of the San Joaquin Local Health District. Si ned (10or Contractor 0 By: j_.-i - -- ---- -------- ----(Title)---------------------------- - ------ - ----- ------ (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). y . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -------------------------------------------------- DATE__/-7_ -;�7_07..6- REVIEWEDBY----------------------------------- ---------------------------- ----------------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DA•TE--------------•---------------- Alterations and/or recommendations---------------- - ----------- ---------- ------ ----- -------------------------------------------------------••----------------- ----------I-------------------------------------------------------------------------------------------------------------------------------------------•-----------------------•----------------------------------------------- -----------•----- -----------------I---------------------------------------- -----------------------------------------------------------------------------------•_---•------------------------------------------------------- :54 FINAL INSPECTION BY---- ----- ---- " --------- -- Date----------------------------------- -------------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.