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,rte--�••-.-•.rte r FOR �OFFICE USE: P -- ---------------�- - Permit No. -1 APPLICATION FOR SANITATION PERMIT ----------------------------------------------- (Complete in Duplicate) Date Issued ---- --- [1p- ------- -------- ----------- ---- :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. JOB ADDRESS AND LOCATIONSZ_,__ .-eve- :-----, ----- -- ------- ---------------- Owner's Name Phone Address !--------"-----•-------------•-•---•---------------•------------- ---.-.----------------------•------------- _ U Contractor's Name-----C-.�A�_w ._ ....�_ ..-.. -------•-------- Phone.-•-•------------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial al,-Trailer Court ❑ Motel ❑ Other Number of living units: _-- -- Number of bedrooms -------- Number of baths ---2!t Lot size ------------------------------------- Community system private Depth to Water TableVft. Water Supply: Public'system 6--- ; Character of soil to a depth of 3;feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 1 No ®< New Construction: Yes �o FHA/VA: Yes El No [4� Previous Application Made: (If yes,date-------- -------- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2U0 feet.) Septic Tank: Distance from nearest well--- -------Distance from foundaation-it?--------------Material------ [-�-� r Ca pacify No. of compartments---�----------------size----- -I- 3__X_6 - --Liquid depth------- ----- -- - , Disposal Field: Distance from nearest well._..'`"'__-Distance from foundation/o---------------Distance to nearest lot line"_ -- Number of lines---•---- -------------------------Length of each line__�4-�--�--- Width of trenc,hp---��------------------ " yType-of filter,material7_6C,_t---- Depth of filter material_ ---------------Total length_-_--f-------- Seepage Pit: Distance to nearest well -------------- from foundation gip--------------Distance to nearest lot liner_--------,- -t :Number of pits---------------------Lining matena'I La(__A_-Size: Diameter--- -��-----.Depth-._ {•------ ------•- Lit Cesspool: Distance fro nearest well.------,-------�--Distance from foundation--------------------Lining,material----...__-_---------------- Depth -------Liquid Capacify-_ -------------g gals. 171 Size: Diameter------------------- ----; --- 1� L l ------------------------E---Distance from nearest•building-=----------------------------------_.-. - Priv Distance from nearest well---------------Distance to nearest lot line------------------------------------------------------------------- -------------------------------------------- _.. Remodeling and/or,.repairing-(describe):------`5` :- - _- -- ,� - 2---- - --- ---- - a ' ------ ----- - ------ - -•----- I 1 i . ----------------------------------------------------------- 1 - ----------------- ---------------------------- = i 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordiriances, State laws, an ru es and egulations of the San Joaquin Local Health District. I _ I. s------- -------- --- (Owner and/or Contractor) St ned - . ------------------- ( 'gl ] ; a - ----•----(Title)----------- ------- `---------------------_ -------------- xBy:------------------------------------ ------------- (Plot plan,'showing size of lot, location of system in relation to wells,.buildings, etc., can be placed on reverse side). E - i FOR DEPARTMENT USE ONLY i E US DATE ----------------------- APPLICATION ACCEPTED BY--------------------------------"--••-- - ------------------------------------ --------- DATE---- ---------•------------------- ---------- REVIEWEDBY---------------------------•-------------•-------------------- BUILDING-PERMIT ISSUED------------------------------------------------ -----------•----------- - Alterations and/or recommendations:------------------------------ - ------------------------`--------------- -------------------------------•--------------- • .` -----•---------------------------------------- ---------- ----------- ----------------------------------- ---------- ------•---------•---------•--------- ---------------------------------------- ------•---------------------- •------------ ------------------------ --------------------------------------------------------------------- ------------ ---------------- .n .� r �. Date::.. -�__� ' -------------- FINAL INSPECTION BY----- -------- `'=---- --- - " ------- ------------ x # . I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazollon Avr. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California _ Manteca,California Tracy,California r.S 9 REViSEQ 6-59 3M 3-•63 F.F-CC. t is