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FOR OFFICE USE: - ------ ------------------------------- Permit No. 7 - APPLICATION FOR SANITATION PERMIT ------------------ --------------- in Duplicate) f ' Date Issued --� - _------------ -------- -------------------- --- This Permit Expires 1 Year From Date Issued j, �' ri f Application is hereby made to the San Joaquin Local Health District for a permit to construct and 414004cr* descr�e .This a plication is-.madeyin compliance with County Ordinance No. S49. f� ^0 _ / 1'r57.2:.S:—_ C: fft c--' y-fI r�a/l�r� A f � _y JOB ADDRESS AND LOCATION-- � I �` rte= Y - —= �!_�t `c� Owner's Name------ Phone = Address--------- --------- p�� --------------------- Contractor's Name_ _ ' rn � �- Phone Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Oth Installation will serve: Residence ❑ pa ❑ i Number of living units: -------- Number of bedrooms -------- Number f baths -------- Lot size Water Supply: Public system E] Community system El- Private (? Depth to Water Table+Vfl_ ft. Character of soil to a dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay'Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Applicaf+ion Made: .(If'yes date____________________J No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from neare ell__df45".__ Distance f om fo ndation_�q-----.-- .Material- ---------- ------ -- ' -- -- A t3/! 7_Li uid de th----- -- ----Ca acit -7 - �+ 00: No: of'compartmenfi S'�--- - q P. P Y f 1, f ! Disposal Field: , Distance from ne rest wella4._�._Distance from foundation---Ljq----------Distance to nearest lot line_S---______._..� . j,.�..�, Number of -------Length of each line- _O -Q'_1-4_-Width of trench__ _ __. ! Type of filter materi :��Depth of filter material__/9_'!___-----._Total length__��37_______________________________ I s „ Seepage Pit: Distance to nearest w l___._-..____'___._____Distance from foundation--------------------Distance to nearest lot line----------------- --......D w..� _� ... Number of�psf ---- '------ ----Lining material-----------------------Size:.Diameter-----------------------Depth--------------------------------�' may. -i Cesspool: Distance from nearest well___________.._-Distance from foundation._..____.__-.______.Lining materia4__________________._____- _-______ ❑ Size: Diameter_ ---------------- ----I----------Depth------------------------ -------- --------r---------Liquid Capacity----------------------------gals Privy- _ . , Distance from nearest well--- 1------------------------- ----------------- from nearest.building-----_-______.__________-_-___F______...El . Distance to nearest lot line-- ----------- ----------- ---- ----------------------------------- ---------- 3 Remodeling and/or repairing (describe):------------------ ---------------------•----------------- ---------------------•-•------------------- 6 •� r ------- ------------------------------------------------------------- r -------------------------------------------------------------------------------------------------------- -- - ------------------------------------------- - I hereby'certify that I have prepared this application and that the'work will be�done in accordance with San Joaquin County�r ordinance , to Ia nd rules and regulations of the-San.Joaquin"Local;Health` District. - ------------------- --- ------------- - - _ _ (Owner and/or Contractor) ---------------------(Title)----- l BY� " - - = - (Plot plan, sho ing size. of_Iot, Iota+ion of system in rela+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY- - -------------------------------------------------------- DATE---='=A ------ ---------------------- REVIEWED BY DATE------------------------------------------------------------ ------ -------- BUILDING PERMIT ISSUED------------------------------ -------------- - DATE.-- _ Alterations and/or recommendations---------- -------- ------- - ----------------- - --------•------------------------------------------------------------------------------.-------------------- - - -----------------------------------•------- ----------------------------••------------•----------- PENAL INSPECTION BY:..' ..--- -- - - - �--- ------------ Date- ----- -,F--�-�-------- --------- -------- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hasalton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton, California Lodi,California Manteca,California Tracy,California 4 ES 9 REvISEC) B-59 aM 3-'63 F.P.CO. 6