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rVKtvrrit.[ uoc: - --- -- -------- --------------------------- ----------- ____------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ c - t � ------------ ------------------------------ k (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued ZAf-2_l1.._47 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 ND LO - , • . -------------/ ---------- - Name '-+� � C�-r--------------- - ---------------------------- Owner'sneu 9 Addressv� ---••----- �_. .0 ......... ter' y Contractor's Namee------- li �..----- ------- ------ _ -------- ------------------- --------- ------ Phone__-= .0 " //7 Installation will serve: Residence A Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____/_ Number of bedrooms -1-- Number of baths __!;k_ Lot size ___ ©____/�_.:- a/____________________ Water Supply: Public system ❑ Community system D( Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand R' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (1 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 5& New 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__ ,f-00-_Distance from foundation----1Q-------- Material_____ __-___ No. of compartments------__7-----------Sizer-x---yt-------.--.Liquid depth---------V-------------Capacity---,/r Q_ - Disposa Field: Distance from nearest well--/0_0.�Distance from foundation----�__/....Distance to nearest lot Number of lines____---------%Y.___•_._ _ ___J- -Lengthe�ngth of each line-----------90 _------ Width of french._______.___- Type of filter material___/ _F+z/« epth of filter material___�� +��Total length....... 1 i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------------- ----..Size: Diameter------------ ----- h...... -------------------------- - Dept ❑ Number o pits..___-----------------Lining material-__-__-_--.-..._ Cesspool: Distance from nearest we4----------_------Distance from foundation.-------------------Lining material--____.______.__________._._________ '� ❑- Size: Diameter--------------------- ----------------Depth------- ------------------------------------- ------Liquid Capacity----------------------------gals . Privy: Distance from nearest well--------------------------------------------_____Distance from nearest building--------------------------- El ____._______._____ -_____❑ Distance to nearest lot line------------------__--------- ------------------------- ------------------------------------------------- ------------------------ Remodelingand/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. (Siner � ..' 9d} s.�''e�c / -------- -------------------------------------------------------------- -Owner and/or Contractor) 8Y - - --- 7 (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-----10- --------------------------- REVIEWEDBY---------------------- ----- -------------------------------- --;`----- ------- ------------------------------------ DATE BUILDINGPERMIT ISSUED ------ -----------------------------------f----------•------------- --------------------------- DATE----------------- ---------------------- Alterations and/or recommendations______________________ •-------------- -- -----------------------------------•------------ ------------------------------------------------- --------- ---------------------------------------------------------------------I----------------------- - ----•-- - ------------------------ -- -------- ----------------- ---------------------------------------------------- --------------------------------------------------------- FINAL ------------------------------------------ -------------FINAL INSPECT N BY:_ - -- ---------- - - Date----------- 6.-------- N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haallon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cr].