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FOR OFFICE USE: r ----- - 1�� -� --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit o. .................... (Complete in Duplicate) y --- ------------ -----= --------------------- Data Issued ---------�-- T_his Permit Expires 1 Year From Date Issued 0Os, �� tirein Application is hereby oaquin Local Health District for a permit to construct and install he work de ed. made to the San J ` This application is made in complianc with County Ordinance No. S49. L JOB ADD ES�N-D OCATION I __ ' /�/ryy((// /f/4{�// p/��/ '` /v�� {/ ___f •_l�- 4____ _____________ _ T ____•- __ -_________••_- I Owner's Name--- ----- ---------------•--------- ----------------------------------- ------ •--- Phonet--••-----•------•-•---•----------- Address__ j ------------------•--- ----- ---------- ----------- t........................-•..__........------• k ----7A.. 1------- r j Contractor's Name------ - --- ----- --------� �• --- ------- -------------------- ------ Phone - - ------ - -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms ---%� Number of baths __ Lot size -------____ ------------•- .: F.. .. "Water Supply: Publics stem Community system Private De th to Water Table ___.___ ft. PP Y� Y ❑ Y Y ❑ p i Character of soil to a depth of 3 feet: Sand El Gravel [-ISandyLoam [I Clay Loam ❑ Clay obe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) 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.) , k -- _ __ . . t------ - ---_ Septic nk: Distance from nearest well__---�______Dis}a e f�Pm $unda�on______a_____...-_.Mat r�I______ . `� `` =v Capacity �oldo V , EIr No. of compartments-----_______________Size_ --e. ---. --Liquid depth--.- -.'- t Dis os Field: Distance from nearest well...�T__ ....._Distance from found tion___ -____.__ Distance to nearest lot line_��_-.___.____. p[ Number of lines-------3_____�___,___�_j________Length of each line-7,0-#— of trench__.. __ _ - d Type of filter material------ of filter material_____l_�_- I.__.Total length__:_ ,t']____________________ y Seeps Plt: Distance to nearest well_____�.0Q-_______Distance f m foundation___._ ±__.____. Distance to nearest lot line-�---------- ;�� Linin material___ _...Size: Diameter__..___ s� o Number of pits--- ---- - - 9 - -*- �.c� ----Depth ��------------------ . , - - ;''Cesspool: Distance from nearest well____..___�_'`-Distance from foundation----------_---------Lining material-----------------------------------__. 30 Size:Size: Diameter------ -- ---------------- =-------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well__.r________________ __':=_-.- f-- :Distance tolot line -Distance from nearest,building.___________-_________--_--------------. ❑ i . tnearest ----'------ -----------------------------------------t------------------------ Remodeling and/or repairing {describe)--------------- =---`-'------------------------•--i------••---------------------------------------------------------•-------------------------------- J --------------'-----------------°•------------------------------------------------------- - ------------------------------------------------ l ¢ G iu r ------------- ---------------------- I hereby certify ha •I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinance�SfateClrules and regulR* f the San Joaquin Local Health District. Si ned - - ----- --------t-- �r and/or Contractor) --------By-------------. - (Title) ---- ------------------- - -------............. (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY rt APPLICATION ACCEPTED BY DATE-----ce .-',r -_�� REVIEWED BY----------------------------- DATE ---- -------------------------------------- ----- --------------- DATE BUILDING PERMIT ISSUED--------- Alterations and/or recommendations---------------------- --------------•----------------------------------•---------- --------------------------------------------------------------- - i ---••------------ -----------------------------------------------------------------------------• c�77 �'°� f .a�°°� *r -- FINAL INSPECTION BY:.� __ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi, California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.CD.