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- -- :.7IV fq ROFFICE USE:----------- ----------------------------_fir-- - �A!�I �ATION FOR SANITATION PERMIT Per No. . .__ _...... ------------------------------ --------------------- (Complete in Duplicate) /Z Date Issued _... ----------- ________________________________________ 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 Co��_ Ordinance No. 5 9. JOB ADDRESS AND LOCATION-----/ -I( ---------------�•------------ -- ..9__L�ln ------------------ .............---------------------------------------------••--- Owner's Name.......... ----. ------- - ------------ ---,----------- -- ------------------- -----: Phone------------------------------------ Address-----•----` 3A`..... ... Oyy--------- - -------- -------------- Contractor's Name------- ... .......................---------------------------------------------------------------------------------------w-----------. Phone.................................... Installation will serve: Residence f Apartment House ❑ Commercial ❑ Trailer Court '❑ Motel ❑ Other ❑ Number of living units: ._____ Number of bedrooms 3___ Number of baths -!'---. Lot size ___/ X__/ Q •________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ort. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date___________________) No in New Construction: Yes FA,'-No ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic;enk: Distance from nearest well-----------------Distance from foundation44----------__..Ma erjal. _G .-Y----------------- No. of compartments_____---------------.Size.....3 -__Liquid depth--------------------------Capacity...tApo - - Disposal Field: Distance from nearest well__ ______-----Distance from foundation.. _--_ __ _________.Distance to nearest lot line--- ........... [(}/ Number of lines----- Length of each line..._r�_�__-_�f________-Width of trench_Z._¢_�_ ____------------- Type of filter material _-GL`s_-_-__Depth of filter materlal__�/_k.______..__._Total length..l6 a...•______________________ Seepage Pit: Distance to nearest well------ -----------Distanm foundation..,lv__.........Distance to nearest lot line---��_._ �� Depth---------Z5'. -- [� Number of pits__--_______.-________Lining material______.o_�.�C_-Size: Diameter_____ .- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------.-------------------_--____-. ❑ Size: Diameter-------------------------------------Depth-------------------- ----------------------------Liquid Capacity.--------------------------gals. Privy: Distance from nearest well----------------------------------------------------Distance from nearest building___-_______-_-________.___._.__-______-_. ❑ Distance to nearest lot line--------- -------------------------------------------------------------•----------------.-------------------•----------------------------------- Re deling aid/or repairing describe):_!4' -_-_- - - _-r_ 0,/! A --- w -------------- -----------------_------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- ---------- ------------- - ----- ------- -------- I hereby certify that I have prepared this applic io a that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o t Joa uin Local Health District (Signed) ------ ---- ------- - -------------------------------------------- ---------------------(Owner and/or Contractor) By:------------------- --•-•------•-•--•-•• -- ------ -- ---------------- -----------------------------------------(rifle)....... -------------------------------- ------ (Plot plan, showing size of lot, location of sys e n relation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------- DATE-.-,-/ --S7- 7- ---------------------------- REVIEWEDBY---------------------------------------------------------------------------- ------------------------------------------------ DATE------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------ ------------------------------ Alterations and/or recom e d tions: `. / 3 ' A1C ------- 1°---•---------------------- FINALINSPECTION BY:.----------4. - ./,�. � --------------------- Date..---- -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 99 9 REVISED B-59 3M 3-'63 F.P.CD.