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FOR OFFICE USE: - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .J--. �'_` _�____ - - ------- ------ ------------------------------ (Complete in Duplicate) Date Issued -----------------_--------------------_------------------ This Permit Expires 1 Year From Date Issued_ DS I.Sro 'O Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the woriherein described. This application-is.made.,in compliance with County Ordinance No. 549. or PJ f401 JOB ADDRESS AND CATION__ _ yj / _ . f ------•-•----------------------------- Owner's Name Q /• Phone-----------------------------------61;E- - Name ----�- y - - � - ----------- d Phone.Contractor's Name------------ •------- --------- Installation will serve: Residence E--"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- Number of bedrooms _-_a3Number of baths�_R_ Lot size _._a-a.�___________________ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table>.$- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ S y Loam E] Clay LoamZN ay ❑ Adobe ardpan F1 Previous Application Made: (If yes,date-----------_--------I No New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'h s r Septic T . Distance from nearest welL___a__-_Distance from foundation--./d--_ --_ Material____--- --� J -�-----____. _Ca acit No. of compartments_-_�__---------______Size_ �,$'��IC_�l�Liquid depth_______.___________ P Y--/---)6A---'O---- � —1 Disposal Id: Distance from nearest- Distance from foundation__/�___�_____Distance to nearest lot line----------------- Number of lines----------- - ___-----_-_Length of each line__lam_. 6l .Width of trench____�=/_ ________________ ----�._____. Type of filter mate ria l___�r�_C__, __-Depth of filter material --------Totallength_ -- ------------------------ Seepag i Distance to nearest well__A-w----------Distance from foundation-_/P__....___.Distance to nearest lot line---- _.__..- r Number of pits---�-----------Lining material__Y'dJl .......Size: Diameter._t;iU-41'_..__.Depth_____ ' ___-.._____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------._______________. ❑ Size: Diameter---------------------- ------------- Depth-----------------=----------- ------ ------------- Liquid Capacity- -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_______-______-___________-__---__-_ ❑ i Distance to nearest tot line- --- -------- ------- --------------------------------------------------------- Remodeling and/or repairing (describe): ---------- -- ------• ••--• .--- ---------=---------------------------------------------------------------------------------------------------•------ -------•------------------------------- ------------------------------------------- 1 d --------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------- -- - ---- --- -------- I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, d rule regulations of the San Joaquin Local Health District. /U---- - - ----------------------------- ------------------------ -4----(Owner----(Owner and/or Contracto (Signed) By---------------------------- ------------------ '--- -- - =------ --------------------------------(Title) --------------- - ------------------------- t, -- ---- -------- ------- (Plot plan, showing size t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ON Y APPLICATION ACCEPTED BY_____ _-_ ' '— -- - - ----- --------------------------------------- - -- -- ------------- DATE---------- -------- ----------- REVIEWEDBY-------------------------- ------ ---------- ---------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED______________________ _ __ Alterations and/or recommendations:----------------___--------------- ----------- ------------------------------------------------------------------------ -------------------------------------- ---------------------------------------------------------------------------------- t -------------------- ------------------------------------------------------- ----- ------- --•---------------------=---------------------------- -------------------------------------------------------- y FINAL INSPECTION BY:-- --------- Date-----�� J �---------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,,Callfornia Lodi,California Manteca,California Tracy,California i ES 9 REVISED B-59 3M 3-'63 F.P-CD.