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FOR OFFICE YJSE: APPLICATION FORS SANITATION PERMIT Permit No. v 7e _7----- ------- ---------- ---------------------------------------------- (Complete in Duplicate) Date Issued ---0-/) -------------------------------------------------- ------- - This Permit Expires I 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 No. 549. JOBADDRESS AND LACATION........ ----------------------------- --------------------------- ------------------------------------------------------------- z Owner's Name--------- ------------- ---- --- ------------------------------------------------------------------- ------ Phone Address------------ --- -------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------------ 1�6 -Ic 0 Contractor's Name-------I------------------- ----------------------------------------------------------- ---------------------------------------------- Phon'. -------------------71 Installation will serve: Residence 0 1-1 Apartment Houser E] Commercial E] Trailer Court [I Motel E] Other ❑ Number of living units: 1_'Number of bedrooms Number of baths j--- Lot size ----- ------------------------------------------- Public system E] Depth to Water Table ft. Wafer Supply: Community system El Privatee__D� Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Lo-a'm ❑ Clay Loam U1dY El Adobe 0 Hardpan F1 Previous Application Made. (if yes,date------------ ------I No 11---New Construction: Yes E] No Ug---FHA/VA: Yes D No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- []t76; �J, No. of compartments--------------------------Size-------------------------------Liquid depth---------------- ---- - - Capacity----------------------- Disposa apacity----------------------- Disposa Field:, Distance from nearest weJI ?!_0 -- Distance from foundation----- Distance to nearest lot line Number of lines ______ - ---Length of each line---------- --------Width of trench......2-.-"/............ Type of filter material--- _Depth of filter material-------Ile---- Total length------------------------- _2__-------- Seepag ------- Pit��,,Itsfance to nearest well_/_&.0/---Distance from foundation-- 9istance to nearest lot line__�___ El umber of pits------1-------------Lining material--t 6i:am r-f-Or'7 -----Depth_.._..._tl_e------------- Cesspool: Distance from nearest well.#_WW*7_Dis'tance from foundation-------------------Lining material___________________._________________. Size: Diameter------------------r----------------- Depth- It------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------- ------- F1 Distance to nearest lot line----- ----------------------------------------- -------------------------��- -------------------------------------------- - Remodeling and/or repairing (describe):-------- -------c «------------------------ -- ----------- ------------ r2t --------- --------------------- ---- -------- ------------------- _Y ---- --- -------- 4 ------------- 5 ------------ -- ----------------- -------- ............. ------ ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, I s, andr(a4negula tons of Ile,San Joaquin Local Health District. (Signed)- - -- -- - -------- --------------------------- ------------------------------------------(Owner and/or Contractor) By:---------- - -- ------------------------ I------- ------- ---------------------------(Title)---------------------------------------- -- - -- ---- -------- (Plot plan, ordinances, s, eof lot, location of system in relafi6n to wells, .buildings, etc., can be placed on reverse side). I , I FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY---- -------- --—-------------Ii-j---------------- DATE....... ?----------------- --------------- ------------- REVIEWED BY--------------------------------------------- :T------------- ----------------- ----------------------- DATE------------------ ---------- - -------- ---------------- BUILDING PERMIT ISSUED------------------------- ------------- -- -------- ------- --------- DATE--------------------- -----------------------------= Alterations and/or recommendations:- ti ----------- --- - -- --- ----------------------I------------------------------- ---------- - ---------------------I------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------- ----------------------------------------------------- ----------------------------------------------------------w-------------------------------------------------------------------- ----------------- ---------- ------- --- -------------- ----------- -------- -------- ---------------------------------------------------------------------------------------------------------------------- r7l IX— FINAL INSPECTION l3Y:.._._A_11 - --------- —--------------- Date------------- - ----------k-- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxoltoo Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California MantQCGr California Tracy, California es 9 REVISED 6-59 3M 3-'63 F.P.Co.