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FOR OFFICE USE: - — _ . ------ -------------------------------------------------- - ----------------__.._.____-_--------_----_.________- APPLICATION FOR SANITATION PERMIT Permit No. ._�. 1.r - --------------------------------------------------- {Complete in Duplicate) $' Date Issued -------- This Permit Expires 1 Year From Date Issued ... .5._ .� 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 LOCAT N + f 5' -------------------------------- Owner's --- ------------- ---- Owner's Name- ---------------------- -----:----- =¢ $ --------- °" ------------ ---------------•-------------------------- -- Phone.-,................................ Contractor's Name------------------------- --- --------------------------------- •----- --------------- Phone................................... Installation will serve: Residence J-] ApartmentHouse I-] CommercialTrailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size .� __________________________________----- Water Supply: Public system ❑ Community system ❑ Private U;,-13epth to Water Table .10_�_ft� 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Se tic Tan Distance from nearest well__..___ ___._0"1 itance from foundation feet . {No septic tank or cesspool permitted if publi sewer is available within 200 No. of compartments--------------------------Sive--------------------------------Liquid de�.th_`•-------------- - Capacity Disposal Field: Distance from nearest well-6-10,00-pi ance from foundation___`a stance to nearest lot Iinp___J_Y___�?^�... Number of lines-.______ �- Len th of each line______ _ - "` 9 1 rr ---Width of trench------ - t - 1 I Type of filter material___ .__ __Depth of filter material_-_- -----------Total length____'..-./f1_�________ { Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------._..Distance to nearest lot line__.______________ ❑ Number of pits----- ---------------Lining material-----------------------Size: Diameter------------------------Dept h-----------------.------__-_-- -- 4 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---- ---------- ---- -- --------------------- ----------- x ,,,k -- = r '� -------�------ ---------�----•-------•--------------- ---------------------------------------------------------------------------------- ----- --- ------------------------------------------_.� -- --_:: --- -------------------- -----------------------------------------------------------------------------------------------------------------------•--------------------------------------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancyS atp I ws, d rules and regulations of the.San Joaquin Local Health District.(Signed - ----- - ------------- ----- - ---------------------------------------------------------------(Owner and/or Contractor) < --- ---- ., ,� BY -.f....:. s----------{Titlej------------------------------------ ---------------- (Piot plan,,showing size of lot, location of system in relatiori_,to.;wells, buildings, etc., can be placed on reverse side). F D AT ENT.USE ONLY) APPLICATION ACCEPTS BY-------------- ---- (1A----------------------------------------------- DATE ---- - .,�------------------- REVIEWEDBY--------------------------------------------------------------------- ' DATE = k 4 ------------------------ - - - BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----- i Alterations and/or recommendations__ ___ __________________ ______ "` ---------- �-Q" i /Q � '�� l 11� ± ----------=�-- ------------ ------------`---------...-.----------------------------..--------•- -----------------------------------------------------•--- --------- --------------------------------------------------------------------• -•------------------------------------------------•------------------------------- t A -----------------•-•------------------- -------------------------------------------------------------I— -------------------------------------------•------------------------------•------- FINAL INSPECTION BY:----- Date--------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Sires! Stockton,California Lodi,California Manteca,Callfornia Tracy,California' ES-9 REVISED 13.59 r.P.CC.2M 6-60 - T