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FOR OFFICE USE: zxow f" .��---------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .................... --------------- -------------------------------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued 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 OCATION.___S /--V ' a � -- --- ------ Owner's Name - <------ ------• •------- - Phone - t-G Address---------- � C-----3- --------- -- ------- ----------------------------------------------------------------------------- Contractor's Name----- --••- -- • -C.r_ - Phone.... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---f___;Number of bedrooms _3_._ Number of baths °9-._ Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _t'pft. 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 2-"- New Construction: Yes P!rNo ❑ I FHA/VA: Yes ❑ No E4 -- TYPE OF INSTALLATION AND SPECIFICATIONS: `�"' "" } t (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well_______ Distance from foundation_Z4?__ ----------Material.;-.(7 -_.__--_-•- Fhl,-� No. of compartments...Z-------------------Size-_S`_NX_- --------_Liquid depth----` `._. .-r Capacity.— Disposal Field: Distance from nearest well-_--.____.-_Distancejroii foundation_��a __~_Distance to nearest lot line-1-57- ---- C Number of lines--------------- --__________Length of each line--- of trench--� _y_---------------- Type of filter material._r/.t'_.G_4_�___------Depth of filter material---� '_-----------Total length__` []_`____________________._ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distanceito nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter---------!-------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-------------------------.-._____.___. ❑ Size: Diameter---------------------- ---------------De th----_-_---------------- ------------ -----------------Liquid Capacity ---..gals. 3Privy: Distance from nearest.well-___________________ _______ ______._____---_Distance from,nearest building_.__.______--__--___________------------ F1 ---- ❑ Distance to nearest lot line-------- Remodeling and/or repairing (describe): ---------------•------------------------------------------------•--------------•------------------------------------•---- ------------••------------------------------------------- ---------------------•---------------- -------------------------------,---------------------------- ------------------------------------------ I ------------------------------------------- --------------------------------------------------------------------------------ar 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 and regulations of.,, San Joaquin Local Health District. F (Signed) - - --------- ------ -------------------------- -----------------------------------(Owner and/or Contractor) 4 By:---------------------------------------=-------- ------ --------------------------------•----------------------------(Title)--------- ---------------------- ................. (Piot plan, showing size of lot, location of,s stem in rela+ion to. wells., buildings,,etc.,_can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ? DATE lU - 7----- 6_x ---- REVIEWEDBY--------------------------------------------- ----- --------- ---------------------------------------------------------------- DATE------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------- Alterations and/or recommendations:------------------------- --- ---- -----------------------•------------------------•-------------------------- ------------------------------------------------------------------------------------- ------------------------------------------------- -------------------------------------------- ------------------------------ --------------------------------- --------------------------------- -------------------------------------------------------------.---`--------------------------------------- -------------------- ----------------------------- -------------- ------------ ----------------------------•---•-------•------------------ -------------------------------------------------------- 1 j FINAL INSPECTION BY:_. _� .L. �----- -------------------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES $ REVISED 8-59 3M 3-'63 F.P.DD.