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A OFFICE USE: ��- � - �,�a�4 � �• � �f APPLICATION FOR SANITATION PERMIT Permit No. ........................ ----- ------------------------------------- -- ---------- _� omp (Clete in Duplicate) .. -- ---------= ---- 'Date Issued . �� ._��_, -- "` This Permit Expires l 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION....__ _1__ -- r/ v ----4,0 .��------------ �---------------------------------------- ... Phone-_9�__1____7_7J`f----- Owner's Name.----••---�-��---•---W{/hl--��-'-:•----- -�-----•------------ ---------- ----------------------- ---------- - -�__---- ' p � - ---------------•------••-----•------•------------------------ --•--------•---------------------------------;. Address - - - -I - - -1 Contractor's Name-__._.....---�1.(t��------------------------------- ••--- - - ---•------------ ---------••------- Phone__ Sj f� --Q.�--------•- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms .r _.. Number of baths l 7, Lot size --------------------.--------------.__________.____________ _-Y Wafer Supply: Public system ElCommunity system R Private Depth to Water Table+• Character of soil to a depth of 3 feet: Sand [1 Gravel ❑ Sandy Loam El Clay Loam E] Clayi Adobe Hardpan ❑ Previous Application Made: {If yes,date--------------------) No F1New Construction: Yes 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 Tank: Distance from nearest well_________________Distance from foundation__-/z - -----.- Material____ SQL __--_ No. of compartments-------- ------------ 0-- - - --3 -Liquid depth------y 1------------Capacity_-I_xr_-_3�---- Disposal Field: Distance from nearest well__- Distance from foundation.__/._ -----------Distance to nearest lot line-$__- `n -�-----------------Width of trench.-_2.1-1------------------ W Number of lines---•-------------------------------Length of each line_.::____-- ,� :r 3 Type of filter material----- -_L+YY___----Depth of filter material________.-___.__'.Total length- --------------- r Seepage Pit: Distance to nearest well----------------------Distance from foundation':_:____-_._______.Distance to nearest lot 1ine----------------- r Number of pits----------------------Lining material----------------------Size: Diameter------------------------Depth-------------------------------- I ❑ : ' Cesspool: Distance from nearest well-----------------Distan_ce from foundation--------------------Lining material-__-________--.___--____________--_ Liquid Capacity--------------------------gals. Size: Diameter_--____ _ -__-----------. Depth . I171 _ i Privy: Distance from nearest-well---------------------------------------------.-.-_Distance from .nearest building_.________---_-____________.-__--______ � ❑ Distance to nearest lot line--------_------- --------- --I ------------ ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------•------------------------------------------- ------ •+ i --------------------------------------- ------------- ----•+---•--------------------------------------------- - 1' "`�`` = ------ ` --------------=----------------------------------•----------- ------------------------------ ------------- I hereby certify that I h ve prepared this application and that the work will be done in accordance with SanAbaquin County State laws, an r les and reguI ' ns of the San Joaquin Local Health District v ordinances, 5ta - � �` �� ( - --------------- --------- -- __Owner and/or Contractor) (Signed}_ �.__ ------------ -------------- ----- --�--------- ---•------ - I - .- ---------------(Tit --------------------------------- ---- --------- ------------•----------------------------- _-------------- e} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). L j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- - ---------- DATE----,��-- ��._-� -------------------- -e----- ----------- ---- DATE--------------------------------------------:: ---------- - REVIEWEDBY------- ------ -----------------------/- -- - ---------- ------------- -----=-------- ---------------- - - ° BUILDING PERMIT ISSUED----------------------------------- DATE - - Alterations and/or recommendations:-------------- -------------------------------------------------------•-------•------------------------------•-------------•------•------------•-------- --- ----------------- - ----•--------------------------------------------•--------------- G ------------------ ------ --------------------•--' --.. _ ..--- ------------------ --- ------ ---------- -------- ------------ } _ f FINAL INSPECTION BY.,.-- .. ..... .. ..... Date_----- / ------- /�,/ SAN�JOAQUI�& N LOCAL HEALTH DISTRICT. 1601 E.Kat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' - E5 9 nEV,SEP B-59 3M 3•'63 F,P.CC.