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F R OFFICE USE: t t_c �- �J' .. 9 _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No.I9 -- (Complete in Duplicate) Date Issued -------------------------- -_.-.... - _ This Permit Expires i 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 No. 549. JOB ADDRESS AND LOCATION - .......... /(-- - y� Owner's Name-------- /.-=..t ........... - 1�" Phone- . .1 Address 5 - - ... -- -----•----------------- 3 --- ---•-- - Contractor's Name--- �/� `•-' 1L" ................................ Phone-------- ---------- ----- ...... Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court la'-Motel ❑ Other ❑ Number of living units: _�.... Number of bedrooms ___/.. Number of baths __� ��:��'-� -..- Lot size ------ ---------- - Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table KP- ft. Character of soil tq a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q-11-ardpan ❑ Previous Application Made: (If yes,date......... ..........) No Zj/'New Construction: YesiEj-_'_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 T k: Distance from nearest well_f_4?T_1_-.Distance fromfoundation.. e--______-Material___ ' .-- .-. No. of compartments-.....-.77--___--___Size-_ x_.r_'Liquid dept--- ..._._Capacity-p:f-e Disposal Field: Distance from nearest well_fi'... Distance from foundation___- -.Distance to nearest lot line..... Number of lines_______________ __ • _ -I...............Length of each line-------�_�_.--tn.�__�__.-.Width of french........-2:�--------_......... Type of filter material....Ir� _ Ir-e.0- of filter material...... R..__l..Total length-____-_ `n-__-_ '-_ _-.__-. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits__________________ ___Lining material-----------------------Size: Diameter...................... Depth................................. Cesspool: Distance from nearest welt.................Distance from foundation------------------- Lining material..................................... ❑ Size: Diameter---- ---- -------- ----s-----------Depth-------------------------------------------------. Liquid Capacity..........................-.gals. t Privy: Distance from nearest well--------------------_............................Distance from nearest building.......................................... ❑ Distance to nearest lot line.....................•---.. .......................................................... -_-____------- ............................ Re-no d__ andfonr'repairing (describe : '� �'/__. ------9-ja ~ -•-•--•--•-------------•-----•-•---._...-----..--_-.....-------- •---•-----•-•-----•-•--•-•-•---•-----------..___------••-•-•------.....--------------------•--.._..._--------------•-----_...--------•----------•---..._ _ t ...-.......; - - • ------•---- -------------•---•--------•••---•---------••-• •-------------------•- -------------------------------- ---------------------_-----------------•----- 1 hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County C ordinances, State lawst, and rul and "egulations the San Joaquin Local Health District. (Signed ' i •••---- ..-..-.. - - - -......... . .......(Owner and/or Contractor) ...... .... . .. ... . , r Sy:--------------------------- --------_ �.........:.............. -••-•---=- ......-..._ -----•------ ----(Title)----------------- - - --- ---- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /t• ----------------- DATE--. / `•----- APPLICATION ACCEPTED BY-----•-__.------. ............... -_ ---__._--------------- - REVIEWEDBY-------- -•................................................:............................................................ DATE-_......................... ------------•---__------- BUILDINGPERMIT ISSUED--------............................................... ----------------------------------------------------- DATE--- ••--•--•• --------------_---•-----•-----•--------__----- • Alterations and/or recommendations:_________________--.________-----_______-----_--___-----------•-------------------------___--__-------•-•-••--------•--•-••--•--•-•----•-----_-------•----•---- -•-•---------•-------------------•--•-••---------...-••-•-•----:--•--......--•--._..__.-..__...._-_.._-..--•----._...._----...•---•----•----•-•---.._._._._....__._.-...--------------------•--•--------------.....---------• .......... --•---•---••--•------•--------•-----•---_.._._..-••........................•--•-••----•-----...--•----...--------....._.___...__..--•-- -•-------...------_...-•-----------------_------•---------......------- ................................•---_...._.-.._....---_._....-------.....-----------------------------------•------•------••---•----•-•---••-_..._..-----..._---•-•--•--------•••--------.._....-----------••.-------••-- ...••-_._.._...--•--- ----- ••- - - - ----------•--------••-----...-_._...-...-.._----.......-..-...-..-•---•--•-.._._---••_._.---------•---•-----•---------•----------_.-....----•-•-•-----------------•-.............. / / ........................... �f - � Date _...-r FINAL INSPECTION BY:._�-.a--.-•- ._ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 f. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy, California F.P CO