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FR OFFICE USE: r.. ------ ----------- APPLICATION FOR SANITATION PERMIT Permit No. 21.... ........ {Complete in Duplicate) h � Date Issued ___I- ------------------------------ 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 County Ordinance . 549. p11, •-•-------------------------------------------- JOB ADDRESS AND L ATION--------.Q_-17.5-5- Owner's Name------- ill QQ' �` ��p-�/1 ""�--------- -------------------- Phone.---------------------•---------•-- - ------ -- ---- --------------------------------------- Address.... �'- .. - ----- -- ----- ---- ----•-------•--•-------------- Contractor's Name-----------------------J - ------ - ----------------- --- `--•--------•------------ Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailpr C urt ❑ /Motel!❑ Other Number of living units: -------- Number of bed -------------- rooms ________ Number of ba#hs '�ot size --/--.3_a --_+�.fl--Q------- Water Supply: Public system ❑ Community system>❑ Private Depth to Water Tabler,;�_-+-- ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑t Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {1f yes,date-----------_---__---1 No ❑ New Construction: Yesx No ❑ 5HA/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_,r4._______Distance from foundation_ ---------Material----P/V.-- �. No. of compartments----- -----------------Size__ ?'[_r ---._�_Liquid depth---- ----------------Capacity-- (7 - / ^�9.._Distance from foundation.�_.�__"__--_.Distance to nearest lot line-----------]. Disposal Field: Distance from nearest well__`,,,?- ...__ (� Number of lines__-..--1------ - __De Depth of filter material____, Width of trench.._a.` ,-_..-___.z_________ Length of each Iine__'gQ_-_.._ �a Type of filter material,__ p 9_________.Total, length------------------�o --- C4 from foundation_-_____..______.___Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well..__________________Distance ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter--------- -------------.Depth----- ----------------- i i Cesspool: Distance from nearest well-----------------Distance from foundation-----_--------_-----Lining'material------------------------------------- Size: --_..._--________--__..______ .___Size: Diameter------------ -------------------------Depth_---------------------- ---------------------------Liquid Capacity---------T--------- w9als. istance from nearest well-________________________ ____________ ______Distance from nearest building------------------------------------------ Privy: D ❑ Distance to nearest lot line------------- ----------- -----•----------------------------------- ---------- ---------------------- Remodeling. and/or repairing (describe)---------------------- ----------- ------------------------------------------------------- ------------------------------- - ------------------------------------ ------------------- -------------------------------------------------•-------------------- ------------ ------------------------- ------------------------- -----------------------------------------------I----------------------------------------------------------------------------- ----- I herebL that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , Sws, and rules d regulations of the San Joaquin Local Health District. t ll� (Signed)---_-- --- ----- ------- --------------- ----------- ___________ __ ______ _IOwner and/or Contractor) -- � ------ ----- (Title) (Plot plan, showing size of lot, location of system i-- rela ' to wells, buildings, etc., can be placed on reverse side). FOR P4PARTjMENT USE ONLY APPLICATION ACCEPTED BY__________ ___ --- --------------------- DATE =�� -��y A � REVIEWEDBY--------------------------------------------------------------- DATE----------------------------------------------------------- kBUILDING PERMIT ISSUED------••-------------------------- --------------• - DATE------------------------------------------------------------- �• Alterations and/or recommendations: ----------ter - ------------ --------- - --------------- - -- --------------------------------------------------------�- ---- ----- -------- ---------------- ------ --- -------------------------- -------------- ----------- ----------------------------------------------------------------------------- f � -------- ---------------------- ~ --------- Date-- --------------- -----��- FINAL INSPECTION BY:.______---- ---�... �- ` -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 RevISEO a-59 3M 3-'63 F.P.CO.