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9/3 F R OFFICE USE: � -------------- (' ------ --------.3 ---------- APPLICATION FOR SANITATION PERMIT Permit No. .•_ /D f -------------------- -------------------------------- .(Complete in Duplicate) Date Issued,,7/ --------------------------------------- This Permit Expires t Year From 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 Po. 549. JOB ADDRESS AND LOC Tl N!.' /y�. ------------ ---------- ------• -------------- -----------•------------------------ -------------------------•----------------------•----- Owner's Name _1L�4/1 - Phone_.. 4 cc Address----•1=D-3-2-------- -----_1- I_ -- ------------------------------------------------------------------------------ -------------- °----------•---------------------------- Contractor's Name. _ `5 =------------•---------------------...._-. Phone--__----.-.-------•--•-•-------•--- t Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living.units: -----r Number of bedrooms _3-__ Number of baths _/_____ Lot size ----------------------- -- j Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table lU ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date ----------_--------) No ff'— New Construction: Yes No ❑ FHA/VA: Yes ❑ No-ems s TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) � rr Septic Tank: Distance from nearest well__-:�--_.._:Distance from foundationik-------------- Material_�__----______.__.._____-_____,_'___�___y I �� No, of compartments_._�______.__-___.__Size____3_x��__7------Liquid depth____4___________________Capacity_.-"pq�-------- Disposal Field: Distance from nearest well_0�.r_---Distance from foundafion_1d__�.______--Distance to nearest lot line__`-__�____ Number of lines_____2_____. Length of each line__7s ---.�_:-________=__.Width of trench _._. _ __'________.__.____ Type'of filter material__------ _.._'Depth of filter material---1--_��_------- Total length_ _ ' -------------------------- Seepage Pit: Distance to nearest well-IP-0__r-______Distanc-a�om foundation_r6.............Distance to nearest lot line__-'_______._ Number of pits--- -------------Lining material.J_.'~`(__'rC_------Size: Diameter._�-------------Depth-----�15--1------------- F 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--------------------------------------- { ❑ Distance to nearest lot line_______________________________--------------------------------------------- Remodelingand/or repairing (describe):-------------------------------- -----------•----------------------------------------•------------------------------------------------------------.-•-- 1 1 ---------------- ---------------------------------------•--------------------------------------------- --•-------------------------------. . . ---------------------------------------------j------ •----------------:-•------------------------------ ----•-------------------------- _ 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 regu tion of the San Joaquin Local Health District. (Signed)------------------------------ ------- --- -------- ------------------ --------------- ---- ----------------------- -----------------(Owner and/or Contractor) 1 By--------------- ------ ------------ --- -------------- --------------=--- ----------------------------------------•----(Title)------------------ ----------------------------_- ------------- (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--"I - *--- 9.�------------------------ --------------------------------------- - DATE---- z ---�.5-----•----------------------- REVIEWED BY-------- ------------------------ --------------------- -I- --------r-------------------------------------------------------------------------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------- ------------------------ - ---=---------------- DATE----------------------------------- --- Alterations and/or recommendations:-_ _- ------ -----1 _g ___ 5. . ----------- ----------------- -------------------------- ------ ------------------ -------------------------------------------------------------------------------------------------- ------------------------------------------- FINAL INSPECTION BY:..Q--x'---�5- ----- Date {_D-.- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-54 3M 3-'63 F.P.CO.