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FOR OFFICE USE: ---------------- ---------- -------- -_______________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ....... ... /U[/ -- --- -- ------------------ - -- ------ ---------- (Complete in Duplicate) ba+e�!Issued ---��{-•�7 ------------ -------------- ---------------------------- This permit Ex Expires Year From Date Issued 1-114 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in comRliance with County Ordinance No. 549. ;€ JOB ADD ESS AND LOCATION l _ r =" --, -------------------------- Owner's Name "f ----•• ---•-------------------- -------------- -- ----------- ----------------------------- Phone------------------------ T--I--- lJ �j Address-------------��_,_7 . ,7_ �l ---- --- -------------------------------�-------•--�----••------------- Contractor's Name----- -- _ l 1— ------ Phone----------,--`•--.-_------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai€er Court ❑ Motel D.II Other ❑ a Number of living units: 1------ Number of bedrooms • _-._ Number of baths -!~.:_ Lot size d D_ ----------------- Water Supply: Public system .❑ Community system El Private X Depth to Water Table �.Cft. ~�~ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date... _..-,,........) No New Construction: Yes :L& No ❑ FHA/VA: Yes ❑ No ❑ u 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---4-(I-------Distance from foundation-_-_ -----Material ------------------------ -------------------- �J No, of compartments__21-.________.--Size.__L_ _ _L+:?471-_Liquid depth---------4/.-_ ----------Capacity_404 4 I Disposal Field: Distance from nearest,well-_d~4------.-Distance from foundation-----.1_b'....._.Distance to nearest lot line-__-,$! __._____ Number of lines____ _ A; --Depth Length of each line_ (� Width of trench---.2-�_-�___________________ Type of filter materi� AL--Depth of filter material ---.Total length---a° _jQ--------------------------- Seepage F ---------------Distance from foundation-------------__---- Distance to nearest lot line----------------- � � t l pit: Number of pifs.rest we---------------------- Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- l r -I' 'f it 1t Cesspool: Distance from nearest well_________________Distance from foundation ------ �A__.Lining material_lt_..-_-_----_---- .______---.--. ❑ Size: Diameter--.------------------------------ ----Depth------ ------------------------------------1-1--Liquid Capacity-------------- --------------gals. 3� Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----1i_._____________-__-_-_--.------_ ❑ Distance to nearest lot line--- ----------------------------------------------------= ----- -----------------1�------------------------------ Remodeling and/or repairing (describe: - ------------------------------------------- ------ A....,..,.. ------------------------- II----------------------------- Z --------------------- -----------------------------------------------------------•--- -----------------------...------------------------------------------------------------------------- ---------------------------------------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with',San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k ----------- - - Y i�' ! (Signed)- ------------------Owner and/or Contractor] (4 r - By:------------------------------------------------------------------------------_---------------------- -- ---------- --------------(Title)---------- -------- ------�•--- ------ ------ .._.e0 . (Plot plan;showing size-of-lot,--location of system in relation to wells, buildings,.etc., can be placed-on reverse side). - ,1 FOR DEPARTMENT USE ONLY -da- - I PIED BY -- - _ -- . - BATE--- --r _ _ . $/ REVIEWED APPLICATION ACCEPTED BY--------------------------------------•-•--- ------- ------------------------------------------------------------------------ DATE---------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------" € Alterations and/or recommendations:----------•------------------------------ --- -------------------------------------------•-----------------------------�--------------------------------- I i ----------------------------------------------------------- --- ------------- ----------------•-----------•----------•----------- 'I------------ ,I / l FINAL INSPECTION BY:._-- :.C% ----------=-------- SANK OAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 LA/Rst Oak Street 124 Sycamore Street 205 West 9eh Street, Stockton,California Lodi,California Manteca,California Tracy,California CS B REVIS£G B-59 3M 3-'63 F.P.CC. a I� r