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-'FOR OFFICE USE: (/ ---------------- --------------- ---------- u 5� APPLICATION' FOR SANITATION PERMIT Permit No. ------------------ --------------------------- (Complete in Duplicate) -------------------------- -------------- # Date Issued ------------------------ This Permit Expires 1 Year_Fro_m 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 County Ordinance No. 549. are ter" .iv r ,P_r�•.r e ,1{ll��!~ ,�9 JOB ADDRESS AND LOCATION�--y- -----f/--�---��---'-------------- -------L------------ ..- -----------. -:- 1_7 Owner's Name------ ------ ----- .I. 'L- f L .-------•-•----•----- ------------------ - --------------------------- ------- - Phone-..-..-----•------- (� ` Address--------•--•-�1----- --- -------------- 1� -�------------------ • ------------ •-•----- -- - Contractor's Name -- - Phone --- ------------------ ------ Ins+a{lation will serve: Residence Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ Number of living units: ---/_-- Number of bedrooms; __- Number of baths --.!-__ Lot size ----- --------- Water Supply: Public system ',❑ Community system ❑ Private ( ( Depth to Water Table 12- ft. 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 [ No F] FHA/VA: Yes Q No [ f b l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank'or cesspool permitted-if public sewer is available within 200 feet.) I ._ tion.. _.Mate.ra�`�wSe tic-Tank. Distance-from,nearest-well _..:Distance from founda 1Q_ X._ _Liquid de th._........ '�---Q-, Capacity. .=------ -----No. of compartments...-- ----------_Size- Disposal Field: Distance from nearest well._.4-0_U._.Distance from foundation___./.-._._...___.Distance to nearest to lines_-__ Number of lines_._ 21 ----------------=-=--�---Length of each line---------qp------ ------Width of trench_-�"-'�.-��------------ I Type.of filter material,5.1--_Depth of-filter mater al____�!_ -- �__-_Total length-_--____.�.SQ__________________.__ I Seepage Pit: Distance to nearest.well--------------------- Distance from foundation_------------------Distance to nearest lot I line-_-----_-_.-----. Number of pits -... __.__.-_------Lining material---------- ------------Size: Diameter------------------ ----Depth--------- ---------------------- Cesspool: n Distance from nearest well-----------------Distance from foundation---------------------Lining ,�.. �.� .P_ ❑ " . _ �`f_.�. � .: --- ---------- Distance from nearest bmldamtegr ia_l---__.._-.--.------_--_.._-_---.-- Size: Diameter----------------------- Depth----------------------------- - =Liquid wCapacity gals ------------------ r nce- from nearest well--------- ------ ---- --- ----------------------------------- i ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------- -------- f Remodeling and/or repairing (describe}:--------- -- '- = ------------------------------------------------------==--.-------------------------- ----------------------•---------- ----------- !! c -----------•------------------ ---------------------------- -•-----------------••--------•----------••----------- ----------------------------------------------------------'------------------------------------r ----------------------------------- ------------------------------- I hereby certify that I have prepafed this application and that the work will be done inaccordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ti (Signed)- ----------- (Owner and/or Contractor) 3, 3 [Ti+le] - Plo+ plan, showing size of,lot,..locition,of system in.relationj6wells, buil_ dings,etc.,._can be placed on reverse FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-=------- ---- ---------------:---- - ----------------- ----------------------- ---------------- DATE-------------------------- ----------------r---------------- REVIEWED BY--------- --`-------------------------------- ------- -- DATE---T------} ( -- - -- ----------- BUILDING PERMIT ISSUED '------ DATE - = _. . :. ---------------------------------------------------------------------------------------- r Alterations and/or recommendations-------- ---------------------- - - -------- 'T --------------- --- ---- ------------------ -, -•--- -- -- -------- ------- ------------- ------------------ - ---- - - --------- - ------- --- -- -------------------------- FINAL INSPECTION BY------------------- --•- ------------------- -- ------------ 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 ES 9 REVISED B-59 CSM 3-'63 F.P.0O3