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F O FICE USE: X" Permit No. 3D kAPPLICATION FOR. SANITATION PERMIT Com lete in Duplicate) - - - - ---- ---- _ { p�A I Date'Issued ------ ---- --- -- ------------------ -------- ---------:--- _ ---- ----- This Permit Expires 1 Year From Date Issue ? Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. This application is made in compliancd with /Coun rdinanceiNo. 549. r 'f7 ----- ---------------------- Phone-_.. ---- -"----------------------"--------•--- JOB ADDRESS AND LO ION-- ---------------------- fPh ----------------- Owner's Nam -- . .---- one ------- •----- ----------- •--•- Address----------- •... --- ' p 7---� r Phone Contractor's Name_- r Installation will serve: 'Residence partment House [ICommercial ❑ Trailer Court ❑ Motel ❑ Other [I/A Number of living units:.]------ Number of bedrooms _3_" Number of baths _4-- Lot size ----------------------- Water Supply: Public system ❑ Community system ❑ Private . Depth to Water Table ft. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [j Adobe 0a"Hardpan C11 /; Previous Application Made: (If yes,date__- ------------) -No L"TNew Construction: Yes No ❑ FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public ewer is available within 200 feet; ��®® Material._! - -- ----------- Septic Tank: Distance from nearest well-`�G------Distance from foundation_-.:_...__ _ r Capacity._._ .CQ_ I No. of compartments__)-: r-----Size-----3-5C---)---?S---)---Liquid depth------- ---- - -".-.Distance to nearest lot line___ ___________ Disposal Field: Distance from nearest well-"h-_._...Distance from foundatior��__-._ _ Number of line s----• --------------------------Length of each IineS --- -------Width of trench.---�c_�--------------------- Type of filter.mate`rial____'._ --k--_.Depth of.filter materia!__-.�_ `__._.__.Total length_._... -------------------------- Type -`-----------------/ 6 /G, ` � Seepage Pit: Distance to nearest -------------Distance ff�from fo ndation l4_.._....._..��nce to nearest lot � __.__ 6 Number of pits: _ . Linin materi�l__IL:�_� --_------Size: Diameter--_-• Deptn__..___._.�3__---------------- Cesspool Distance from nearest well-----------------Distance from foundation.-..-.- ------_.Lining material--.._--_.--.--__-- _------ /Q 11 ❑ Size: Diameter.'_#----------------------"--- -.-----Depth_.-------------------- ----.-Liquid Capacity.-------- gats. Privy: Distance from nearest well------- - """Distance from nearest..building-_._-_--__-----__----------------.--.- - r ❑ Distance to nearest lot line-------- ----------------------------------- ---------------"-------------------------------------------------------- f Remodeling and/or repairing (descibe):_..---"----------------------- --------------------------•-------"------------------- ' I ,. ------------------------------- --------------- ---------------------- --------------------------------------- ------------------------------------------------ t ----"-------------------------------------------------------------------"------•------------------------ .------ ----------------------- ----------------------------------- --------------------•-------•----•----- -- ----- --------------------� ---------- --------------------------------------------------------------------------------------------------------- 1 hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the an Joaquin Local Health District. -------------- C t , . ._ Title - ----------Owner and/or on -c St ned __- d/o tra ori f ------ - ---- BY: - ------------- - - -- - 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). ZL .- t. FOR DEPARTMENT USE.ONLY DATE J�Z—G ` - ---- ------ -- --------- ---------------- APPLICATION ACCEPTED BY = - f =� -,REVIEWED BY------------------------------------------ DATE BUILDING PERMIT ISSUED--------------------------------------------------------------- ------_------------ - ------ DATE--------------------------------- --------------------------- Alterations and o at' ns:--- -, or reca --------- - --- A.- ---------- -- --- - - ----------------------------------••----------------------•I ----------- ---------- ---------- r - 1 Date--------`--n------�� ------------- I - ------•----I FINAL INSPECTION BY:----------- 9t'r.--------------------------------------- F SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Haielton Ave. 300 West Oak Street F "' 124 sycamore Street 205 West 91h Street Lad!,California Manteca,California Tracy,California Stockton,California ES 9 REVISE=D 9-59 3M 3-'6a F.P.CD.