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FOR OFFICE USE: ---------------------------------------------------------- -- --- ----------------- ----------- ------------------- --------------------------------------------------- -----------------_._._____________.______..__._.._________ APPLICATION FOR SANITATION PERMIT Permit No. _.Z.7/0.7 ------------------------ ------ f (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued .______- �f�__f? Application is hereby made to the San Joaquin Local Health District fora permit to construct and alt ff P install he work herein described. This application is made in compliance with County OrdinancA No. 549. JOB ADDRESS AND LOCATION--------- _fe /!Z -_ --- � a'A -- Owner's Name `fit------ ----- f �' ---------------------- - Address--------................ 9.7------ Phone._.4• - /CSS a .----------•-. .. .- . Contractor's Name---- Installation will serve: Residence-Apartment abuse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_.__/__ Number of bedroom_s ________ Number of baths ________ Lot size ------------------------------------------------- Water Supply: Public system ❑ Community system � Private Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay .Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE:OF INSTALLATION AND SPECIFICATIONS: _ x (No-sepfic tank or cesspool permitted if public sewer is available within 200 feet.) _ m Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ❑ No. of compartments------------------------ i i• Size--------------------------------Liquid depth--------------------------Capacity---------------- --Disposal ield: Distance from nearest well...50----------Distance from foundation___ -----------Distance to nearest lot I ,e___,S Number of lines__._ -------- Length of each line-------Id-.0----_---------Width of french------2....... .------------------ Type of filter material__ Depth of filter material____�_e-------------Total length_-_./Q_a-----__________________-- -0 � Seepage Pit: Distance to nearest well------------------ Distance from foundat ion--------------------Distance to nearest lot line_-____________-. ❑ Number of pits------ ---------------Lining material---------------------_Size: Diameter--------- ------------.Depth------------------- ; Cesspool: Distance from nearest well-----------------Distance from foundation__:__-------------Lining material-._.___ - - -----------------•--- ---� 11 ❑ Size: Diameter-- i---------. ---------------------De th------------------------------------------------------ p . Liquid Capacity---------•---------- -•---galsAw Privy: Disfance from.nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Di stance ___ .________________Distance to nearest lot line--------------------------------------------- - ------- ----------- ------ --- Remodeling and/or repairing (descr be):___ --- -- ------------ - -• -------- -----------•-------------•--- 1 ----------------------- --------------------•------ --------------- ----------=- ---.---------- ---- --------------------- ----------------------•--------•----------------- ------------------------------- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and re Wien f the S Joaquin Local Health District. i I (SignedB --- _ - -----------------------(Owner and/or Contractor) BY - -- ------- •-------- -----------------------------------(Title) (Plot plan, showing size of t, location of,system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- . -------------- ------------------------------ -- DATE_,!73_74� REVIEWEDBY--------------------------------- ----------- ------------------------------------------------------------------------------- DATE ---- BUILDINGPERMIT ISSUED------------- - -----------------------------------------------—-------------------------------------- DA•TE_--- ------------------------------------ Alterations and/or recommendations:'------------ --------------------- ------------------- - = -------------------------------------------------- -------•--- -----------------_-----------------------------------------------------------•----------------------------•--------•-----------------------------•-=---------- --------------------------_--.-------------------------------.y-.---------------------- ---------------------------` ---•------------------------------------ 1 ------------_------------------------------------_--- FINAL INSPECTION BY' ---•--•- - ------------ 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 ES 9 REVISED 8-59 3M 3-'63 F.P.Co. ;�e