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ylFOROFFICE USE. .2 1 -- ------ ------ --- ----- ---<< -T -Q -t `�-_.... APPLICATION FOR SANITATION PERMIT Permit No. .__/_ --------- ---------------------------------- -I-%.0 (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 AND LOCATION----- - -- - - ----------------------------- Owner`s Name_--- _ 7- --- -Address-------------:3Q_1 �� = A. ---------------------------------------------------------------------------_--•----wa- •-------------• -------- _ c_. -•-------• ---------•----------------- ----._ Phone-_b�.k-_l Contractor's Name------- .G�s.1 �' 7 Installation will serve: Residence JZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms __3-- Number of baths __ Lot size ____ i_ 0--_________________________ Water Supply: Public system ❑ Community system ❑ Private 79 Depth to Water Table i4n_ ft. Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes ❑ No FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan • Distance from nearest well-----------------Distance from foundation___________________Material..____.________________.__•_______-._.________. ❑ No. of compartments-------------------------Size-----_----------------------Liquid depth---------------- ---------Capacity Disposal Field: Distance from nearest well---6D_-------Distance from foundation-----!a?___._.__.Distance to nearest lot line__ '_____._. Length of each line------- _-....Width of trench___.__.2SL (� �� Number of lines---•--------�------ a--- _-__-- Type of filter material. • - ---_-Depth of filter material_-_____�_-k`-__.____Total length-__.___-______________c3�.>_'_.------ Seepage Pit- Distance to nearest well ._-__---Distance from foundation------I_a--------.Distance to nearest lot line----�S___i--____ � dNumber of Pits------I---------------Lining material_.5_,_ eC---Size: Diameter---------33- -----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):_____ntj-_.__` -_-E - L --------------------------------------------------------------------------------------------------------------•---------------L--------------------------------------------------------------------------------- ---------- P ------------------------------------ -----------------••---- I ---------------------- ----------------------------------------------------------------------------------------------------------------------------------•----------------------•---------- ------------------------------ I 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. (Signed)------------- CS f rl �------I- - -- ---------- (� ----------------• - ------------- ------------------ -- ---------•------------ ---.{ ner and/or Contractor BY=------ �9r� ---------- ---------5-----------------------------------•----------•------------(Title)------- -- --------------(Plot showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � -------------------- ---------- DATE_._ _�� ' REVIEWED BY ---------------------------------- ---- ------------ ------ DATE----- --- ---------•---------------------------------------- BUILDING PERMIT ISSUED---------�•------------------- -- -----•--------- - ------ ------DATE---- ----------- Alterations and/or recommendations:--' ��r-(Q `f �(�l�/1------�---- ----- --------- ----- ---------------------------- ---- --------- -----------•------------------------------------------------------ --------------------------------------------------------- ------------- ----------------------- r ---------------------------------•• ------------------- ------------•----------------------------------•-------------------------------------- ------------------ --------------- ----------------------•----------- I FINAL INSPECTION BY:.._ ? --- - I?/_ �,Z -------------- - Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.F.Ca.