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OROFFICE USE: �� G� ., / -------------- ------_-------------- APPLICATION FOR SANITATION PERMIT r –j—Permit No. ...1..7!_._YY ----- ------------------------- ---------------- -- (Complete in Duplicate) f3 Z i This Permit Expires I Year From Date Issued Date Issued �:F 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 co m fiance with County Ordinance No. 549. M-`7_ j3q_ p g 2.53f'S �rt,�� -- JOB ADDRES SAND LOCA ON----- Y.- � � - { G � . j ---_-------------- -- ------------s--�/� Owner's Name---------- t �1 �' ' ... j �'� - Phone �� _! V Address----------- ------- DN_OY'1 ..._Ret.-----------. Contractor's Name------------------- ---••----•-------------- -- Phone----•---...------- -• ---- - •-------------••-------------•-•--- __...--•-•------ Installation will serve: Residence & impartment House ❑ Commercial ❑ Trailer Court ❑ MoV_ _ Other ❑ Numbter of living units: -f-:--- Number of bedrooms _3 Number of bath_- Lot size -----/! _. -��_- � Water Supply' Public system ��mmunity system ❑ Private ❑ Depth to Water Table __ftoft- Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: . (If yes,date------- -...........) No New Construction: Yes f�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: aDistance' from nearest well _77-----Distance rrom�foundat pn__/0---------- terial No. of compartments-.__� _______ Size__l ___ - --' Liquid depth___ Capacity Disposal Field:: Distance from nearest weli_- �_-_._Distance frorri`fcundation--_ _ r �-- � ----------- ___..---.Distance to nearest lot I�r,e___�----_---- (`f7 Number of lines--------- _ -------------- -- - Length of each`line--�-----`�'Q-p------------Width of trench------p2 Type of filter materiaI_,j I h�Depth of filter material-------/-.1--�1----Total length_____..---- ------------- ---------- Type _------_ Seepage Pit: `Distance to nearest well------------___-------Distance from foundation--------------------Distance to nearest lot line-_._______--_-.._ ❑ Number of pits- Lining rnaterial --------------------- ----------------------Size: Diameter----•------------------Depth----_------------------.- . ---� Cesspool: Distance from nearest well__---------------Distance from foundation------------------- Lining material------------------------------------- El Size: Mameter------ ---------------I-I---------------Depth--------- --------------------------------- -------Liquid Capacity-------------------------• 9als. Privy: Distance from nearest well-=_-_.__._- ._____-.._±------------- -----Distance from nearest building El Distance to nearest lot line ---------- f ------------------------------------------------------ Remodeling and/or repairing (describe):--------------------------------- - -- ----------------------•----------- -- ---------------------------------------------- ----- ----_-----------------------------------_------------------------------_--------__________________----------------------_-------------------------------------------------------------------------------____________________ ' f 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la and rues and regulation the San Joaquin Local Health District. (Signed) yf ` ---------------------------------------------------------------------(Owner and/or Contractor) BY: ------------------------------------:-- ------------------------------------------------------(Title)-------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY ----------------------- ----------- ----=------------------------ 1.'•. 1 RATE . `. REVIEWEDBY -------------------------------------------- `------ ----------------- DATE-:----------- _......------------------------•-- BUILDING PERMIT-ISSUED ------ - ----- - --- ----- DA - Alterati ns and or ecommendation, ._ ---- --- - - '-- . n, �- - -- t -------------------- ---------------- - - ----------- - - ----.�.��•--------.tea---5e. f ------- J -- / : -------- ------------ ----- ------------- - -- - FINAL INSPECTION BY:----T-- ----- ------------------------------------------------ Date------ ----- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT &12 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-•S3 F.P.CD. _ f