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OR OFFICE USE: ---- -- �� -�--------—----------------- --------- ---- -- ---�-�----•- -- � --- APPLICATION FOR SANITATION PERMITPermit No. ------- .( ompDate Issued Clete in Duplicate) ----- -- � ----- -- - - ....- ---..�._..__. - _ ______ ___________ -This Permit Expires l Year From Date Issued ---------- Applicafiop is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a i de in m lien with nt Ordinance No. 549. r P t. JOS ADDRESS ND LOCATION___ _ _ ' ' ,,1l��----- ---- ---- - �jf fl ._ Phone_.. ------------------------ ---------- Owner's m ----------------- .. . ----------- / -------------------------------Address 1 7 -- I---- ------------------------------------------------------------------------------•-•----------•------------------------ --- Contractor's Name__.- --------'----.3-- 7 ---------------- Phone..............--------------------- Installation will serve: Residence [g--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .� Number of living units: _.j____ Number of bedrooms __3-- Number of baths _.7— Lot size ___ ___. --------------a----------------------- Water Supply: Public system E] Community system ElPrivate UR--17e"pth to Water Table _,6�dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe trHardpan ❑ Previous Application Made: {If yes,date--------------------_I No [q" New Construction: Yes �No ❑ FHA/VA: Yes ❑ No a' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ •�c ''Septic Tank: Distance from nearest well__ __ __� . 0 .--Distance from foundation_j_,(�_-______-Material_.0 _ [� ----------------------------- ---------- ______________________ ------ --Size-----No. of compartments--- iquid depth-.--' - --------------Capacity--.fyUu Disposal Field: Distance from nearest weiL_�S_------Distance from foundation._� -----------Distance oto nearest lot line__A7/___- t --------------Length of each line_---74k-----------------.Width of trench----o2__ --��--------------- .' Number of Isnes_______.�.___---_ r Type .of filter material`P_0_f��-----Depth of filter material___:/E'--„_-------Total length---1�5l-O__ ___________________ Seepage Pit: Distance to nearest wet€---4Q4..........Di stance from foundation___------=�".___.Distance to nearest lot line__ __._ j Number of pits._. -________--_°Lining mater':al._Jt�_C_ _____.Size: Diameter____2 _'._.___Depth____.,�5 �________- �1 t I .Cesspool: Distance from nearest well--- -------------Distance from foundation---------------------Lining material.------------------------------------- Size: Diameter----------------- # -----------Depth------------------`------------------- -------------Liquid Capacity ....gals. Z ? ;Privy: Distance from nearest well------------__ --------------------------------.-Distance from nearest building._,-_..___________.____________.___--- -�.•�� ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------- -----------5------- - 1.1" t uRemodeling and/or repairing (describe)---------------------------i ------------------------------••-----------•--------------------------------------------- ----_- -_____ _________________________�________.____-____'-_____________e_______._..__.__._________________.___________.-____ ______-_____.__._____.________._._______-_______.___..--______._____ .________-•_________. _____ _______________________________________••______________------_____----`------------_- ------'- r �� .. _ } '-------------------------------------- --------------------------------------------- ---------------------------•------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joao;uin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---------- ----- {------------ ------ ------- '----------- ---------------'- - -----------------{Owner and/or Contractor) c By---------------------- - ------------------------------------------------------------------- [Titlel _.._..... (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc.,.,can be placed on reverse side). E I FOR DEPARTMENT USE ONLY Sys,-t- ------------ APPLICATION ACCEPTED BY= ------------ -- - --- DATE - ` REVIEWED BY----------------------- ---------------- -------------------------------------------------------- DATE --------------------- BUILDING PERMIT ISSUED-----•------ -------------------------- ---------------------------------------- ------ DATE----------------------------- --- - � * - '� ---- ---------=_-------- Alterations and/or recommendations:__ ._ _ _-_ �'� -"' -------------------------------- ----------------------------------------------- ----------------------------------••---------- ------- -4 ----------------------- -------------------- --------- ---------------------------------------------------------------------------------------------=----------- .. ----------------------- ---------------- ' 'I FINAL INSPECTION ---- ---------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Ca.