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FOR OFFICE USE: ------------------------------ ------ ----------------- - __________________________________ P6 APPLICATION FOR SANITATION PERMIT Permit No. /.!k/`--3: ,_ � .. {Complete in Duplicate) ,t ------------ ---------------- This Permit Expires i 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 here' desc bed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS"AND" OCATION_= ------� "�"`' = •�/ ----------------- Owner's Name----------- ! . ..... --•------------• -------------- --------------------------------- -------- Phone---------=-------------------------- Address__----......&!:.- --.;3 -�`�•-— -------- '•----- - -----•------------------••--•-•---------•------------------------ Contractor's Name Y >C�_.. ..---------•--•---•--------------------------•----------------------------• --•------------------------ Phone----•---•-------------------------- Installation will serve: Residents IN Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_._- Number of bedrooms __ _._ Number of baths . -__ Lot size `�?r_ c• ___.__ -0,t 3 _p -------------- - 'Water Supply: Public system ❑ Community system ❑ . Private [Tj'] Depth to Water Table,.5__'0_ ft. Character of sail to a depth of 3 feet: 4 Sand ❑ Gravel ❑ Sandy Loam 2 Clay Loam ❑vClay ❑ ' Adobe [] Hardpan ❑ Previous Application Made: (If yes,date____________________) No [R, New Construction: Yes [2� No ❑ FHA/VA: Yes ❑ '-o ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: INo septic tank or cesspool permitted if public sewer is available within 200 feet.) +'` Septic Tank: Distance from nearest well---47�0-------Distance from foundation----- �� Material J No. of compartments-------�-----------_ --------------Liquid depth--------Y1-_`-------Capacity_-P�°--------- DisRgsal Field: Distance from nearest well----_S -� O__.-__Distance from.foundation- -d-----_ __.Distance'to nearest lot line---- Number of lines-'_3-------------------- Length of each line----- --4-------..........Width of trench-----�_----_--------------.-- Type of filter mate�iaW �_-fa Depth of filter materialr_1-g_--:__r,,___.-Total length---�a._.---:+ " - z -1 # .� Pit: . Distance to nearest we€I___ t?___._______Distance from foundation--------------------Distance to nearest lot line__-_ .----_-- •. // ❑ Number of pits__#---------------Lining materlal/Llt�i�L._._,_.__size. Diameter-_7'I'_. - ----:_Depfh -IPI_-------_-_-__._.--__ Cesspool: Size:Distance Dimeter --- nearest well- -------------Depth ' --------- Distance from foundation _ .______.Lining material___.._._____-____-_----------________- ---- Liquid Capacity- --------- --------------gals. Privy: Distance from nearest well-------------------------------------------......Distance, from nearest building_------____._________________.____.-.__ Distance to nearest lot line--......-- J Remodeling and/or repairing (describe):___ . . = r 1 ------------------- -------------------=-----------------------------•------------ ------------•--------- -- ------------- ----- --- �-•------------------------------------- -----------•---- -------------------------------- t I - . - --- ------------------=---------------------'--------------•-----------------------------------------------•---•-------------------•------------------- ---------------------------------- c 1 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. a {Signed) �� 1 4, ,e< t-1t~ - -- - . - - - ---- ---- Owner and/or Contractor) �� rte,-••--r .. BY:------------- - {Title) (Piot plan, showing size of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEQ BY ----------- DATE------ ----------------------- - = -- REVIEWED BY - ------------------ DATE BUILDING PERMIT ISSUED------------------------------------- ----------------------------- DA•TE---------------------------------- - I----------Al terations and/or recommendations:' -------------- ------•-•---- ----------------------------------------------- ------'---------- ------------------------ ------------------------------------- FINAL INSPECTION BY____ ____ _ __ _ _ `�, T Date ---------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CaliforniaLodi,California Manteca,California I. Tracy,California :. ES 9 REVISED 8-59 31A 3-'63 F.P.0 D. -