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-------------- -- ---- -- ----- _ ------------------ --- ------------------ _ ... _.. -- ---- --- - - '� �. APPLICATION FOR SANITATION PERMIT - --- -- - (Complete in Duplicate) Permit No. .--- -SP1- This Permit E fres 1 Year From Date Issued Application is hereby n ` Date Issued ____ `� 3 y made o the San.Joaquin Local Healfh District for a permit to construct and install the work her This application is made in co►�pliance,with-County Ordinance No, 549 � � �© 4^. �$-o^�� herein described. JOB ADDRESS AN LOCATION._•___ . .t" . �, Owner's Name----- "fit= ------------------- ---•- -------•---- -- Address •------ _ Q ----- •--= - ....P --1- 1 s - Phone.---- ----•----- Contractors -7------------•--- Name_ �✓— � [�c Installation will serve: Residence Dd Apartment House •------ -••--- Phone................................... .Number of livingunits: _--I ❑ Commercial ❑ Trailer Court --_ Number of bedrooms ___�_ Number of baths f-_: ❑ Motel ❑ Other ❑ Wafer Supply: Public system. l .Lot'size -___- ❑ Community system ""---------•----- __________ Character of soil to a depth of 3 feet: Sand ❑ private Depth to Water Table _S7 ft. ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Previous Application Made: (If yes,date________________ } No ❑ Clay ❑ Adobe TYPE OF INSTALLATION AND SPECIFICATIONS; New Construction: Yes Hardpan ❑ ^� No ❑ - FHA/VA: Yes ❑ Not � {No septic tank or cesspool permitted if public sewer is available within 200 feel.} Septic Tank: r p� / Distance from nearest well_ __Distance from foundation______ j� No, of compartments__--_-___ i__ ----- -0----_.Ma e�rial-_-___-_ -_ r Dis osal Field; _ - - -------Liquid depth--- �r --"- -"----- p Distance from neare f well--- _pisfence from foundation.__- - Capacity__ __�v� Number of lines. ___ ' _____ -.__Distance to nearest lot line-__ Type ----------------Length of each line yp of filter material ____ g �-_�G��—�a ----- Width of french----- - `! fY __Depth of filter material �T_ fr "- Seepage Pit: Distance to nearest well_,--•----------------- - Total length------�_7�•------------------- a► Distance from foundation_____________------Distance to nearest lot fine------------------ p Number of pits._._______-_ ' --------Lining maferial_-------- -- ----Size: Diamefe�_____-__-- Cess ool: -----------..Depth ------- A Distance etc nearest well----------------Distance from foundation-------------- material--Size: Diameter__-- -- -_ -- - Depth ------------------- "- Nivy� �- '•Distance from nea�esf welly "rs� - ------------Liquid Capacity_---- ------_gals. i _---Distance:from'nearest building_ _ El Distance to nearest lot line____________________ ' ------- ------------ -----------------------Re L elin nd/or�r.epairing (describe ----- s -- ----- 7� Q y ' ------------ ------ ---------------------------------------------------------•------------------------------------- _ __ ______.________.__________-__--_____--________--._______________________I-_-______.__________ __.___________.______-________________________-___.-__________. I hereby certify that I have prepared Phis application and that the work will be done -- accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. } (Signed)----- ------ ---------------------------------------------------------- - . ' °Y_:•--------------•---- �- - - --- ---- ----- caner and/or Ca ct (0nfra or) {Title)--__--. (Plot plan, showing size a lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ' REVIEWED BY - DATE_ BUILDING PERMIT ISSUED -_-_------------- ----.- DATE-- --- DATE and/or recommd � "�•- ---- ons:------ - --- -------------------------------------- .---- ------------------- ---------------------------------------------- FINAL INSPECTION BY--------------- - - -•- _ _ �� � d SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Masellon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,California ES 9 REVISCD 5.59 3M 3-'63 r.Rra. Tracy,California