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F R OFFICE USE: /6M _-_ �__.6_.-________________ -- y ------------ ------------------------------------- 14 " APPLICATION FOR SANITATION PERMIT Permit No. APPLICATION .. _3 -: (Comple#e in Duplicate) /6 r, Date Issued ----------------- ----___--___-___--_-.-_-_------____ __ This Permit Expires 1 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. 9 � JOB ADDRESS AND LOCATION,-// ------- ----------------------------------*-------------------------------------------------------------------- Owner's Name---- ... Phone_---------------------------------- z5 ___ ___ _ _ •_•_____ _-_ Address-------- - -- - ------ - -- --------------------------------------------- Contractor's Name-------------- ---- - ---- C---------------------------------------------------•--------------•--•--- ----------•-------- Phone Installation will serve: Residence M p rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: :__if__ Number of bedrooms „_._ Number of baths I----- Lot size � Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table & ft. r Character of,soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [!r—Hardpan ❑ -4 Previous Application Made: (If yes,date____________________) No New Construction: Yes ��o E] FHA/VA: Yes F] No �r � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well_"_-___Distance from foundation ------------_Material_______-_l`--�._----____________-_--_--____. r f No. of compartments____�L____-------------___Size_�_�_�_7__._.____liquid depth__�_____-_-_----------Capacity----��_-_`'rl y r y Disposal Field: Distance from nearest well-`------------Distance from foundation _______________Distance to nearest lot line__�_.__�.... i Number of lines------/___-____,__+_______________Length of each line--`�--I-f-____--�--______.Width of trench.__-��_----__________-_____ Type of filter material-_-TO-C-<---------Depth of filter ma#erial__ _____--__Total length-----5�'0___________________________ Seepage Pit: Distance to nearest well---~__________---Distanc�e m foundatiory6 (__________.Distance to nearest lot line__'S-_-_�______ Number of its____ _ .Linin material_____/(' - _-.Size: Diameter__3• -.�a-----_:Depth----a J- -------------- , P g Cesspool: Distance from nearest well-----------------Distance from foundation--------------:---- Lining material-------------____:_____-__------_____. m ❑ Size: Diameter--------------------------------------Depth--------------------------------- ------------------Liquid Capacity-- ----------------------7-.gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------________----___-______::_____-_- I ❑ Distance to nearest lot line----------------------------------------------------------------------=------- -------------------------------------------------------------- i I Remodeling and/or repairing (describe)_------_-------------------------- _ i ---------------------------------------------------•-•------------------------------------------------------------------------------•----------------------------------- ------------------------------------- ---------- --------------------------------- --------------------------•---••------------ ------•------------- --------------------------------------•-----------------•---------------•- -------------------------------------------•--------------------•------------------- -----------------------------------------------=--------------- ------------------------------------------------------------------------------------------------------------------------------------- 1 1 hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re do s of th San Joaquin Local Health District. (Signed)-------••------------ -----•- ----------- ------ ---- ------------ ---- - -------------------------------------------------------------------------- ---(Owner and/or Contractor) By:---------••-------------- --------- -•- •-• -- - ---------- - --------------- ------------------------------------------.-(Title)--------------- - -----_----------- ------------------- (Plot plan, showing size o ca to of system ' relation to wells-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ' ---------------------------------------------------------- DATE-------� -- 74...----------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE---•------------------------------------------------.------- BUILDINGPERMIT ISSUED-------------------------------------------------------------•----------------------------- ------ DATE------------------------------------------------------------- - -------------------- Alteratig nip /orecommend* s: C ... ------- --------------------------------------------------------- •------------•---- - •----------------------------------------------------------------------- ------------------------------- i =----------- ----------------- -------- ------ ---------------------------------;------------------------ ------------------------- --------------- --------------------------- - ------------------------- - 9- FINAL INSPECTION BY:-- = _•`Cr [s '----------------------- --- Date----------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton A4.' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California . , Lodir California Manteca,California Tracyr California ES 9 REVISED 8-S9 3M 3-;63 F.P.CO.