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O OFFICE USE: --------- --�--� >+Z -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION-_LOCATION--f--9--- ---9--- --�G---y---�------------------------------------------------- ---------------------------------------------------- Owner's Name__-_1Ll_____.__.. 11� Phone-------------------------- - - - ---------------------------------------------------------------------------------------------------- ------- - Address............{�_c .lam - -fi r'-:-�-----•--•---------------------------------•------------------------------------------------------------------------•------------------------------ Contractor's Name-- . -- ( J T�_... ---------• Phone----------------------------------- - -•-.-••- ---------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths --I---- Lot size ---------- Water Supply: Public system 21--community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adohetf"Hardpan ❑ Previous Application Made: (If yes,date-__--- -------------) No [ New Construction: Yes Ur-IN, ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept nke �J _ ------------ Distance from nearest well-----------------Distance from foundation___________________.Material_--______---------_________________-. �+ No. of compartments---------- --------- ----Size-•------------------- ------Liquid depth---------------- ---------Capacity------------- ---- Disp6��'T Distance from nearest well- "__---_Distance from foundation-4 f-__-_______-.Distance to nearest lot line___3...______ Number of lines.--•-----•�-----------------------Length of each line------41-----------------Width of trench.----' - -_-------_---_------- Type of filter material____9PG'f-----------Depth of filter material---fn_-------------Total length-----44-----------------------___.____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-_-_________ u/ ❑ Number of pits----------------------Lining material--------.--------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: ---------------- ------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)_____________________________________ __ __ 9' ---------•-------------------•--------•------------•----------•----------------•------------------------- ---------------------•------------------------------------------------------------•------------------------ ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------•-•---------------------••-•---•-------------------------------- ----- -----------------------------------------------•-------------------- ----------------------------------•------------------------------------------------------------------------------------------------------- ---- 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 ;Cldegulafions of the San Joaquin Local Health District. (Signed) -- --- ` ---------------------------------------------------------- ---(Owner and/or Contractor) By: - ------- -------------------------------------------------------------(Title)---------------------------------------- --- -- (Plot plan, 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-------=-:ate-----4r - - - REVIEWEDBY----------------------------------------------------------------------------------------- --------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------•---------------------------------------.. DATE------------------------------------------------------------ Alterations and/or recommendations: .------------------------- - ---------•- moi° - -.. ----------- ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINALINSPECTION BY:--------C= 14 --------- ---------------------- Date----------` �----------------- ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. f