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FOR OFFICE USE: \ w-t-__ _., &1-------�� / APPLICATION FOR SANITATION PERMIT � lJ Per 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-1/1-C9----- ---w-/�-w �' z -----------------------•--•---•------------------------------------------ --•-------------------- Owner's Name_ / � ,.�C �^ -------- •--- Phone.._- 4::?�-r-72---------- Address--- -----....Address__- --', ------------------------------------------------------------------•--•-----------------------------------------------•---•--------------------------- Contractor's Name---- -{ - - - --------------------------------------------------------------------------------------------------- Phone..--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: .- ____ Number of bedrooms --/-. Number of baths ---1- Lot size ---a_�"X...d1Q � Water Supply: Public system J Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,(X Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R New Construction: YesK No ❑ FHA/VA: Yes ❑ No-K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation_____.-_..._.--_--Material------------------------------------------------- No. of compartments--------------------------Sii---------.-.---..------ -----.--_Liquid depth---------------- ---------Caacit Disposal Field: Distance from nearest well istance from foundationl. �Distance to nearest lot line_jLa Number of lines_____________/.__.______,__ Length of each line-----.Rp--___.Width of trench._____ _f!��--____.___ Type of filter material____ l&.____Depth of filter material--49'- ""`__.Total length______ : '_ ____ Seepage Pit: Distance to nearest well Distance from fgVridatio8 .._..Distance to nearest lob line-A19604- Number inty_A - r� Linin material_- _ __ � 'S___Depth__ Number of pits______.fi______ g Size: iameter _ -____... Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter------- --r----------------------------Depth------------------------------------------------------Liquid Capacity----------------------------gals. Privy: ,Distance from nearest well__.-____---------------------------------------Distance from nearest building---____________-____-_•_---____--_.-___._. a ❑ Distance to nearest lot line-------------------------k---------------------y------------_-----------------•-------------------------------------------------------- i. Remodeling and/or repairing idescribe)------ ate.'--- ---- --- - - -----------------------------------------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.1trid rules and regulations of,the San Joaquin Local Health District. (Signed-- .� ` -------------------------------------------------------------------------------------------------------------1:( wn and/or Contractor) !l.Cl� ---------------- ------------------------•--- ---------------------------------- (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---C.. = �- - ----------- DATE---3 ----------- -' !''' ` ' (----------------- ------------------------------------------------------ REVIEWEDBY-------------- -------->...--------------------------------------- ---------------------------------------------------------- DATE PERMITISSUED..........------------------------------------------------------------- ---------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:_._ __(a_i--------------- C5.....= i ----------------------- 0y�}------------ •.; ---------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-----C__ 1'`'-------•----•------------------ Date-- 3..-._i_ ..r. I------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod!,California Manteca,California Tracy,California E5.9 REVISED a-59 F.P.00.ZM 6-60 E\ i