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FOR OFFICE USE: / �f-----------------------9-`'" •APPLICATION FOR SANITATION PERMIT Permit No. ------- ------------------------------------ ----------- _. 1_� - ----------------------��- -�`� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --- App ication __Application is hereby made to the an Joaquin Local Health District for a permit to construct and instal( the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION " �'`�`� `r�----�1-�-�---- `' --- Owner's Name---- --- Phone-_- _v �_ •s>_-c- .-- Address------11I-7-------- --------------------------- Contractor's Name------- '" �----------------------------------------- ------------------------------- Phone----------------------------------- Installation will serve: Residence Zj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J.___ Number of bedrooms 3_._ Number of baths ___/___ Lot size ____fwd_X_1-_57-0___________________________ Water Supply: Public system ❑ Community system ❑ Private ;9 Depth to Water Table-•.0 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 ❑ No ❑ 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__�0.--____Distance from foundation_ _k�_--___.._.Material.-- �' 'SY.____ ______- • - c "Z No. of compartments___.. _... _ ______---Size_ n_ _q..-_--- --.Liquid depth----�.................Capacity____�4 Disposal Field: Distance from nearest well_._6.0-_!._Distance from foundation--_-4 /-------Distance to nearest lot line---- Number ine___ Number of lines____-3_______ __________ _______Length of each line----- G'._.--__jl_..______-Width of french-"�"..-7------- --------- 4 _.-..___ Type of filter materiai__.��45. __._-.-Depth of filter material___/__________.__Total length____. _''7R--_____"/�- ______-____ Seepage Pit: Distance to nearest well----_--------___------Distance from foundation--------------------Distance to nearest lot line_._____________ n ❑ Number of pits------------------ .--Lining material____-. Size: Diameter-------------- --------Depth__._____._____.____________.._ Cesspool: Distance from nearest well-----------------Distance from foundation----------------- _.Lining material----------------________________- ^ ❑ Size: Diameter -- --------------- ----------------Depth--------------- --------------------------.--------Liquid Capacity- --------------------------gals. Priv Distance from nearest well-------------------------_--------- _Distance from nearest building ❑ Distance to nearest lot line.- --- -------------------------- ---- ----- ----------------------------------------------------------------------•---------------------- Remodeling and/or repairing (describe):--------- --- ------------------- ----------------------------------------------------------------------------------------------------------------------- lfi ---------------------------------- ------------------------------•--•--------------------•-------------I----•---•-----------------•-- --•-----------------r---------------------------------------------------- ----------------------------------------------------------------------------------------------------------------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, nd rules and regulations of the San Joaquin Local Health District. (Signed)--- - - -------- -- -------------------------------(Owner and/or Contractor) --------------------------------------Til _ (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_ [. 30--74?�- --------------------- REVIEWEDBY---------------------------------- ------------ -- ---- -- ----------------------------------------------------------------- DATE------------------------------- -------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------ ^ ' yAlterations and/or recommendations:__- _.__-K` ______________/ _ --- -------- �-- -- __"_" "_____________ ____- --- � ___________-_______�_ -- .._.___.__^__..____ _ __.-..____.__.____.---___._____-.____________________________________ ----------------------- --- .... -- . --- ------ --- - -------------------------------------------------------- ---------------------------------------------------------- _ ---- ---- -- ------- ----------- ------------- ----- ------ ----------------- - -------------------------- - ------------------------------------- --------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: C _ -- J----------------------- Date_.. = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C9.