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7V;0 FFICE USE: -----------�/ w!�`t Permit No. -L..7A �, �" __ 'APPLICATION FOR SANITATION PERMIT f ----------- ---------- -- (Complete in Duplicate) Date Issued __-- This permit Expires 1 Year From Date Issued I A,pplication tis.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 compliant 4 with County Ord'snan No. 5 9. JOB ADDRESS 21A LOC TION. . `3 - -- �----------- Ph ---------------------- � ------ - --------- one ----•---•---- Owner s Name r s -•----- ----------•------••--------------------------------•-----•---•---•- -- ----------- - Phone Contractor's Name-------------•-------- •-- ------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E] Motel El Other (� Num - ---Number of living units: _-._ Number of bedrooms _ Number of baths -------- Lot size .0�-----------------•"--------.".-----•--- ----------- Water-Supply: Public system Community system ElPrivate F1 Depth to Water Table S- ft. Character of soil to a depth of 3 feet: .Sand [IGravel❑ Sandy Loam ❑ Glay Loam ❑ Clay ❑ Adol,e Hardpan ❑ date.- ----------------I No New Construction: Yes�.No E] E]FHA/VA: Yes Previous Application Made: {lf yes, No E]_ E] TYPE OF INSTALLATION AND SPECIFICATIONS- E (No septic tank or cesspool permitted if ublic sewer is-available within 200 feet.) Septic Tank: Distance from nearest wellj- _-Distance from foun�djatiorl+l0_Q" MateJial_ .1� ---------------z.-� Capacity 9' ---Liquid depith-_-;/----------------- Disposal � No. of compartments—_._O ------ ---- � Disposal Field: Distance from nearest well/!�f/{!f�G,Distance from foundation_ �Q __.._.Distance to nearest lot line___-"..____._S Number of lines---- -------"- --- --- ---- -Length of each line_--------t�; -- ---Width of trench.------- -y------------•- - Deptli of filter material___' _Total length--------------------- __4 of filter materialt_l� """ "" Distance from fo ndation_447 .Distance to nearest lot line____S!_._____ D Seepage Pit: Distance to nearest well_/[ f__40_--: .� S Number of pits.- -I--------------Lining material----,_ --Size: Diameter....33----------Depth---------- .-� W Cesspool: Distance from nearest well_________________Distance from foundation----___._-_____.--..Lining material.-.________:-__-___.______.___-_.___ ElSize: Diameter---`----------------------------------Depth------------------------------------ --------------Liquid Capacity-- -------------------------gals. N lst building-------------Distance from neare Distance from nearest well--------- ------ ' Privy: a 3 Distance to nearest of ine----------------------------------------------- ------- Remodeling and/or repairing (describe)--------------------------- -------------------------•--•------- -----------•---------------------------------------•----------•-------------'----------- r ----------------------------------------------------------------------- ------------------------------------- - , --------------- -. �... �. --------------------------------------------.---------- I ---------------------------------------------- --•-------•----------- I her c tify that i have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc s, St a laws—,,an rules and r ulations of the San Joaquin Local Health District. i 1 ' _.. i� caner and/or Contractor) (Signed)---- --'& -- ------------------- ---- r (rile) t By--------------------- (Plot plan, showing Size of� lot, location of system in relation to wells, b ridings, etc., can be placed on reverse side). r FOR DEPARTMENT'USE ONLY ------ DATE------ . 1 1`----------------------- APPLICATION ACCEPTED BY ��. REVIEWED BY I------------------------ - -------------- - ---- ----------- DATE.-------. -- BUILDING PERMIT,,_ISSUED----•----•• E---------------- - DATE --- ----- - - ------------------------- --------------------------------------------- Alterations and/or recommendations:- -C - e -----�0 " �� -�-- '�"- - ----------------------------------- ------------------- -----------------------•------ ------- ---------------•---------- ------- ----------- ------------ 4 FINAL INSPECTION BY:----- = Date 4 � ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT } 1601 E.Haselton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California {'•1Nanteca,California Tracy,California : ES 9 REVIBED B-59 3M 3-'63 F.P.CO. .