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FOR OFFICE USE: -------- --------- -------- --------------------------------------------`---------- APPLICATION FOR SANITATION PERMIT Permit No. 12_d�o9_y ------------------- .(Complete in Duplicate) --------=-------J This Permit Expires 1 Year From Date Issued Date Issued 1---/Z___ 6' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he wo re' described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------------------------------- .r -;� � --_ - =' ------------------------------•--- Owner's Name--------- s.------i(�t.,m1-11 .._ --------- ---------------- Phone-.A-3}.�7�/0-7? Address-------------- ,1 - --------------- -----------------•------ ---------.--------- -------------------- i ------ - ----------- Contractor's Name--------- _ �.S" ` ., iPh . one__ .-. `J_ _• -tom__------ Installation will serve: Residence Apartment House ElCommercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number o g �__ Number of bedrooms •� f baths Lot size ___1�-_Q--�- f Q ---•-----{--------------------- Water Supply: Public system.40 Community system ❑ Private ❑ Depth to Water Table -------- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe D4 Hardpan Cl Previous Application Made: (If yes,date-------------------- No ❑' New Construction: Yes�f No E] FHA/VA; Ye No E]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_4•.VV____Distance from foundation_--�t�__-/_--_._.Material-____L _ ' • .e No. of compartments----- ` Size- �� Liquid depth------ - --- ----Capacity----/,J_71 - Dis o aI Field: Distance from nearest well.��p f--Distance from foundation._ S----------Distance to nearest lot line---��.__�__ Number.of lines__________ _ _ f � Length of each line_____ .-�__----- ____--Width of trench.____ Type of filfer material___. __L Depfh of filter mafierial--_.__s±?— Total length____-- Seepage Pit: Distance to nearest well---_-------------------Distance from foundation-------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------,� Cesspool: Distance from nearest well---_----------.__Distance from foundation ._____---:_---.__..Lining material____________________________________, d ❑ Size: Diameter___-. ------------- Depth--------------------- -------------------------------Liquid Capacity gals: � Privy: Distance from nearest well ___________ __ ------------------Distance from.nearest building------------______---_--------------------------- F1 ____---_______ _.___.__._ f n ❑ Distance to nearest tot line------ ------------------ " ----------------------------------------I---------------------------------------------- -------------- V ' Remodeling and/or repairing (describe)---------- --------------------------------------------- --------------- --------------------------.� ----------••--- -- ------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------- ---------- ----------------------------------------------•----------------------------------------------•------------ ------------------------------------- -------------------------------------------------- ------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (5igned)----------`- '``�.' `' "-- I ' '' ------------------------(Owner and/or,Contractor By= ----------------------••--------------------------------------------------------------------"----------(Title)--------- (Plot 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 BY------------------------------------------------------�-y-`-----------=-------------------------- DATE - REVIEWEDBY--•---------°----- ----------------------------------- ------------------------t - ---- --------------------------------- DATE------------------ --------•---- ------- BUILDING PERMIT ISSUED------------------------------------------------------------=---------------------------------------- DATE - - - -- -- -------------------- Alterations and/or recommendations-------- ---------- ---- - -----------------------------------------------------•-------------------------------- --------------------------------------------------------------------- ----------------- ------------------:- '--------------- --------- ------------------------------------------------------------------------------------------------------ ---------------------------- ------•-- ------------------------ ------------------------------ `_---------------- --------------•-- -----------------------------------------------•------------------------------ ------------- FINAL INSPECTION BY:. Date---:�----------- J T f• r. _ _ SAN JOAQUIN LOCAL HEALTH DISTRICT SAA= 1601 E.Naaolton Ava- 300 West Oak Street 124 Sycamore Street 205 West 9th,5treer Stockton,California Lodi,California Manteca,California Tracy,California ,SES 9 REVISED 8-59 3M 3-'63 F.P.CD.