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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------------- . (Complete in Duplicate) - --- -- .. . � r _ _ Date Issued � '`` Data Issued This Permit Expires 1 Year From Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBD RESS AND LOCATIO , � IFI`._._. -------- ------------------------=-------------------------------7- Owner's'Name------- Q _ � .. Phone---------------------------------- Address---------- - --- --------------.. - - --------------- ---------- r � Contractor's Name = ' r-c - - /Qrrt'i.G_.�r-, e-------------------------------- Installation will serve: Residence ❑ Apartment House 0—.Commercial ❑ Trailer Court ❑ Mofel-lp Other ❑ Number of living units: 6_____ l;Number of bedrooms `_7--_ Number of baths 4_-__ Lot size ._--�_.�.c�_c_____________------------------ t _ Water Supply: Public system .❑ Community system ❑ Private ffJ Depth to Water Table-!P;? ft. Vl Character of soil to a depth of 3 feet: Sand ❑ Gravel cl Sandy Loam ❑ Clay Loam.]. Clay ❑ Adobe ❑ Hardpan. ] �^ J Previous Application Made: (If yes,jdate- ---__.._._- -_-) -No'["] New Construction: Yes ❑ ' No 0 FHA/VA: Yes ❑ No ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet) - Septic Tank: Distance from n crest well ------Distance from foundation--------_----------Material-------------------------------------.______-__. ❑ No: of compartments---- = == Size `_Liquid 'depth Capacity Disposal Field: Distance from nearest well_________________Distance from foundation-----'--------------Distance to nearest lot line----------------- ❑ Number of lines-----------------f-'.-------------Length of each line----------- -------------.Width of trench--------------.--•------------------ f , 10 _.Type,of-filter_material-------------------------Depth"of filter material_,_-_!---------------Total length-------,------------•----------s---------- Seepage Pit: Distarice to nearest well-/-&70--/--------Disfam:fe from foundation D' �,e to nearest lot li ._. J "N tuber of pits----- ---------:."° Lining material- Size: Diameter------------ - -_ Depth__-_�! --- -------- Cesspool: Distance from nearest well___--------------Distance from foundafion.__________.__.___.Lining material--.-----____________.________.____.__- Size: Diameter---------------------------------------De th-`---------------------- t---------- ---Liquid Capacity -------- gals, Privy- ,Distance from:nearest we'll-------------------------------------------- ---Distance from nearest building--- ❑ Distance to nearest lotlgline-------------------------------------------------------------------------------------------------------------------------------------------- i Remodeling and/or repairing Idesc l3e�: � i _ -• e----�'s�_�_"__ --------------------------------------------------- -----------------------------=---------------------=---------------------------------- - . I -------- ---------------------------------------------- ------------------------ ----------------------------------------------------------------------------------------------------------------- ---------_-----------------------------------_---------------________________________----------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws and rules and regulations of the San Joaquin Local Health District.'.. (Signed)------- dam , ---------------------- --------------------------------------------------------I-- ------:(Owner and/or Contracfor) ,F- z-By --- ---- --------==-- -----------=----=---------------="---------------------------------•------------------(Title)---.: ----------------•-•-� ----- ---- r - ------ (Plot - (Plot plan, showing size of lot, Iota on of system in relation to wells, buildings, etc., can be placed on reverse.side). - t f_ FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY__ R - ------------------------- - ---------- DATE } - REVIEWEDBY----------------------------------- -- -----.------ ----------:-- --- ----------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--•----•- ` _ --------- DAT -------------- --- -- ----------- ---- Alterations and/or recommendations:_-____ /}� s �___________ - / 1 ------------------------------------------------------------•--------------•- ------ ------------------------------------------------------------------------------------------•----------------------••-----•-------•--- r: i ---------------------------------------------••---------------------------------------------------- - -------------------------- ------ -------- - - ------------------------- - -- --- - ----------- ------------------------------------------- -------- FINAL INSPECTION BY: --- ------ ------ ----a Date-- ------ - -- --------------------------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 f.PME3.