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FOR OFFICE USE: ----.-- ALICATION FOR SANITATION PERMIT Permit No. _. 2...�. ..� -------- -- ----- -------------------------------------- (Complete in Duplicate) , / ------ --------- - - --------------------- ------------- _ This Permit Expires 1 Year From _Date Issued 11 Date Issued ______/ __ S Application is hereby made to the San Jc;equin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 549. 1 JOB ADDRESS AND L -OCATION --f� `L, -------------------------------------------------------- i Owner's Name-- -------- -.lZ---- -------...e�r�------------ • ------ -------------- Phone------------------------- Address '' �` f '•'`- ------------- • r E Contractor's Nama_____-- � --- _-- Phone------------------• Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other'-❑ Number of living units: Number of bedrooms --.- Number of baths ___L Lot size ._.___°_______ __ _ _ ____ Water Supply: Public system ❑ Community system ❑ Private [_ Depth! to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date---------_--------) No ❑ New Construction: Yes ❑ No-E], FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------------...------------------------------- No. _ -._ _ � ❑ No. of compartments Size -----------------�-Liquid dep�h--------- ---------------Capacity---------------------- lilt. ----------=---------- '� a IifU a 1 Disposa Field: Distance from nearest well___.�p_____Distance from foundation____________________Distance to nearest lot line___ Number of lines:__...._1. . - _ - Length of each line__-1�(-Q_'_______________Width of trench_-_-__�-".----. ----- Ty _. ______ .� r Type of filter material--_________ s_____Depth of filter material___--/_�________-_Tota'ength--------- _�_.:_ __________�'________ Il. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line___= ❑ Number of pits----------------------Lining "Material-----------------------Size: Diameter-----------------------Depth------.--- .--------------- I l Cesspool: Distance from nearest well__ ____________Distance from foundation--------------------Lining material-------------- ----------/#....... F1pSize: Diameter--------------------------------------De th--------------------------- ---Li Liquid Capacity --------------- ----- q - ---------3------------ gals. Privy: Distance from nearest well__________________________________ _____________Distance from nearest building-----------------------------f__:__.__._- ❑ Distance to nearest lot line---.------------------------------------ _ll' � '. Remodeling and/or repairing (describe):_-- -t ��----------------------------------------.------ ----•• -----------------.-. -- - - --- = = -------------------------- R --------- ------- ---------•----------------------- , - - ------------------------- i ----------------------------------------------------------- I hereby certify that I have prepared this application=and that the work will,be-done in accordance with San Joaquin County ordinances, Sta aws, and rules and egulations of the SA Joaquin Loca I4ealth Dis trict. fj4 __ --- ad/or Contractor) d I " .� - lM-y i By: ' s_ _ :_: 4r — I: {Title) (Plot plan, showing size of lot, location of system'i relation•towells,..buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - - -------------------------------------------------- DATE---3-- 4- -7 '11- -- ------ REVIEWEDBY------------------------•---------------------------------------------------------------------------------- ----------------.. DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—----- -- -----------1----------------- DATE.------------------------------------------------------------ Alterations and/or recommendations:--------------------------- --------------------------------------------- ----------------------•-- ------ -•- -------•---••------------- --------- l� 9 - t --------------------------------------------------------------------------- --------- ---------------------------------------------------- ill -------------- ------ ---------------- -------------------------------------- ------------------------------------------1-------- -------------------------------------- -------------------------------•----------------- ----------- -------1�------------------------------------------ ---------------------------------------------- ------------------------------------------------------------------------------•----------- FINAL INSPECTION BY:.--- -------.-._ Dated .. `-G SAN JOAQUIN LOCAL HEALTH'DISTRICT ' I 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycarnore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracyr California I ES 9 REVISED 8-54 3M 3-'69 F•P.DO.