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J FOR OFFICE USE: t --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- ------------------- --------------------- -- ------------ (Complete in Duplicate) G Date Issued -=-1 This Permit Expires 1 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 C unty Ordinance No. 549. W..1_Vo.�,.Car_7�� r211 'G.mss � - JOB ADDRESS AND LOCATION ?A - �✓_` rJ >r ------------------------ �--r��4� / Owner's Name------------------------------------- , --------- ------------------•---•----------- ---------------- :�-------------------------------------- Phone---------------------------------- - Address---`-0---� ----��'&�!/ � 1_' -..l ` ------ --`•-------- �7.�----------- Contractor's Name--. - .t. -- ----- Phone •--- ---------- ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------- 00 ' xS--o-�-------------------- Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand A Gravel ❑ Sandy Loam ❑ Clay Loam N. Clay ❑ Adobe a Hardpan ❑ Previous Application-Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well-,4S.D___Distance from foundation------------------Material---- -___-_.--. ---'.--------. l Size_-_----�-___X, -_ Liquid de th_-.__�.------ --Ca acit . COQ-_.--- ❑ No. of compartments °�� q rP. p Y f 7---- Disposal Field: Distance from nearest well- Q-..._Qistance from foundation-��U�------_----D,,,-.i-.sj�ance to nearest lot lin ---�(69-__--- "y ❑ Number of lines------------ Length of each line-/ ~_�qn_ idth of french------- - Type of filter materia{----jpt_t4!�s- Depth of filter material----. ��_-_----Total length-----. �'------------------------ ,i i Seepage Pit: Distance to nearest well----------------------Distance from foundation-------...-.--------Distance to nearest lot line-----------.----_ C ❑ Number of pits------------------ ---Lining material-------------.---------Size: Diameter-------------.----.----Depth--------------------------------- Ci . Cesspool: Distance from nearest well-----------------Distance from foundation_.__--___----.-_..Lining material--...-----------_____.-.-_-------. �I Size: Diameter--------------------------------------De th-------------- - ---------------------------- -----Liquid Capacity als.i Privy: Distance from nearest well---------_--------------------------------------Distance from nearest building--_-------_-_______-_------.-----...-. O� ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- h 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. (Signed) --- ----- (Owner and/or Contractor(, By� G� -�"--- A {Title) t/ '�`.c'@ 1 (Plot plan, showing size of lot, Iota+ioystem in.relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- -------------- ---•------------------------------------------------------------------ DATE------------------------------------------------------- REVIEWEDBY------------------------------------- ---------------------------------------------•---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------- -------------------------------------------------------.DATE Alterationsand/or recommendations:----------- ------------------------- ---- -------------••--------------------•--------------•------------------------•--------------------------------------- -------------------- • - -------------- --------------- -------------------------------- -------------------------------------------•----------------• - •---------------------------------.---------------••---••---------- -------------------------------------------------------------------------------------- ------- ----------------------------------------------------------------------•-- -•-•------------------------------ ------------•------------------------------ ----------------------------------- ----------------------- ---------------------------------------------------------------------------- --------------------------- -------- --------- ----------------------- FINAL -------------- --- A FINALINSPECTION BY-- --------- ------ ----------------------= ----------------- Date----------------1--.'.~,(-- ----------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazelten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISE❑ 8-59 3M 3-'63 F.P.CO. 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