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FOR OFFICE USE: // // '---____-_!_..-_------ APPLICATION FOR SANITATION PERMIT Permit No. ..1-(Q--�3-11 ------------ --------- ---------- ---------------- (Complete in Duplicate) - Date Issued ----- -------------- ____________________________ __x _ , __., _,«._ _ t This Permit Expires 1 Year From Date Issued f 2/ —1 o�g- 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 �ATION-1�!__ --_--- .-�-~_ ____---- _._. - Owner's Name-------- ---------- - -------------------------- --------------------------------------- Phone------------•------- Address--------------._.r � k'Yt.�.. ------- ----- ------ ------- -- ------------------------------------------------------ ---------......---------- Contractor's Name------------------------------------------ ------------- -- -- `--- __ ' --•---------------- Phone.. Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of bedrooms c;?-. Number of baths __/ Lot size ._- _• _____________________ _____________________ Water Supply: Public system ❑ Community system ❑ Private)K Depth to Water Table - ft. r Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------_-----------) No ❑ 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_ _______Distant from foundation___ / Material_ _ ___________________________________ P p f No. of compartments(;- fad_ _�f_____Liquid depth__!V2---_--------Capacity- Disposal Field: Distance from nearest well_.4 _70------ Distance from foundation._O ---------_Distance to nearest lot line__:.......... NumType of filter material__��_ �_Depthhofffilterhmlal~f_8_'� Width of trench.___ , ._� .___ Length ----- Total length/0_e_'____ , Seepage Pit: Distance to nearest well---------------------Distance from foundation------------.-------Distance to nearest lot line__________.___.._ ❑ Number of pits_____________________Lining mate rial------------- -----_---Size: Diameter-----------------------Depth-----------.--------------------- I t Cesspool: Distance from nearest well-----------------Distance from foundation.__________.___._-.Lining material-_____--______-__-__-__-_---- _- _._ F-1 Size: Diameter.-----•-------------------------------Depth----- ---- ------------------------------____._Li quid Capacity- - ------------------------9als. c Privy: Distance from nearest well----------------_________-_______-----°------Distance from nearest building------------------------------------------ 1-1 Distance to nearest lot line.------------------------------------------------- ------.--------_----------�------------------------------------------------------------------- -•� Remodeling and/or repairing (describe):--- }'{ � __ J ?. .�� " ...---- t -- -•-. - .-.--.- ~ = --------------- -------------------------- ------------- �• -----------------------------------------------•--------------- �,� ----- L �' � --•----------------•--------------------------------------------------- -------------------------------------------------------------•-------------•------ ------------------------------------------------------------------------------------------------------•------------------------ ---- . I hereb tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances-:�, laws` and rulesand regulations of the San Joaquin Local Health District. (Signed)----- ------- ----------------------- -----=-_ = - --- -------------------------------- ----- Owner and/or Contractor) ------------------------------------ ------------- ---- ------- ---- -- Title --1-----------... (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY-- ------ ------------ ---------------------------------------- DATE-- --------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- --------•----------------------------------------------------- DATE------------------------------------------------------:------ Alterationsand/or recommendations:--------------------------------------------------------------------------•-----•-----••-----•--•----------------------------•-------•----------------------- -------------------------------•- ------ ------------------------------------------------------------------------------ -•-••------------------------------------------------------------------------••-----------••-------- ---------------------------------•----------------------------------------- ------ ------------------------------•-------------------------------------------------------------------•- ------------------------------------- ----------------------•----------------------------------------------------------------------- --- --------•------------------------------------------------------------------------------ -------------------------------- --------------------------------- ------------------------------------ -------•------------- ------------------•-----•--------- ----------------------.----------------------------------------------------------------------- FINAL .INSPECTION $Y:.__lJ �t- ". ------------------ Date---- - .� ----� - - - ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-s9 3M 3•'63 r.P.c O.