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FOR OFFICE USE: -� -------------- APPLICATION FOR SANITATION PERMIT Permit No. ... ------------------------- --------------------------- (Complete in Duplicate) Date Issued ---- --------------------- ------------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construc d install the work herein described. This application is made in compliance with County Ordinanc�, , JOB ADDRESS AND O ATION._------- _--_-- ---- ---- --- --- - -- ---- - ------1�: .=/--_.� .. TC / -- Owner's Name ------ Address - ------------- P/hone . .. Address - 2 f / v5/42Q. t Contractor's Name................................... ---------•----------- -----------------------` -------------------------------------------------------- PhoneA(4(pt..,--------•- Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms Number of baths A.... Lot size ---1`?�!.x----- .......................... Water Supply: Public system 09 Community system ❑ Private ❑ Depth to Water Table _ J. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe N Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ER New Construction: Yes ❑ No Ya_ FHA/VA: Yes ❑ No ❑ 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---____-------Distance from fbundation--------------------Material------------------------------------------------- f% t,4-oVG No. of compartments--------------------- ----Size-------------------------------Liquid depth------------------------.-Capacity--_------------------ W Disposal Field: Distance from nearest well----.------------ Distance from foundati n._...r-------------Distance to nearest lot line Ir S Number of lines------ tnn__-----------Length of each line___. ----------------Width of trench------z -. ¢ '_`-_----.-----•. � Type of filter materiaL�_........! __Depth of filter material----I__g`.....____.Total length_____-_-_�__.S------------------------- J ' f Seepage Pit: Distance to nearest well.._-No --_--Distance from foundation___- -------Distance to nearest lot line---I_e-_-__---- [4 Number of pits... Lining material__9oC�--:__----Size: Diameter----3-3.............Depth----ZS!____-_----_-___--_ 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------------------------------------------------------------------------•---•-----•----------------•----------------------------------------- �. Remodeling and/or repairing (describe)=------`�`�l_'11-- -- ---------- ---- --- ---- ---- /O 0 ---------------•---------------------------------------------••-----•-------------•---------------------------------•-------•---•--•-------------•---------------------•-----------------------•----•----------------------- -----------------•-----•--•-----•------------------------•-----•------------------•---------------•------------------------------------------•--•-----------•--------------------------•----••----•------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------- I hereby certify that I havepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulatio of the San Joaquin Local Health District. - -------------------------- - ------ -- ---- ------------- (Signed) - --- ------------------------------- Owner and/or Contractor ( / , By:. -- -- ----- ----- ------- -- (Title) -- -------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place-An reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- t R_ ---------------------------------------------------------------- DATE.---1--0 =--f cy --- X1_1--------------------------- REVIEWEDBY----------------------------------------------------------------------- ------------------------------------------------- DATE--------- -------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:----ti.._:Z._L,(0A--------1 .--'.►� e__ -----"------��a........f_-,-:�....... A--- --------------------------------------------------------------------------------------------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------•---------------------------•------------------------------------------ ----------- --------------------------------------- ---------------- ---------- --------------------------------------------------•-------------------------- -----------•-------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--- 5----------------------------- Date----t.0= Z- lQ. ------------------------------------------ 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 ES 9 REVISED S-59 3M 3-'63 F.P.CD.