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>=oR oFFlcE usE: --..- --- ------ ---------- Permit No. - _ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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 County Ordinance No. 549. JOS ADDRESS AND LOCATION Vis! i � 7�.... - -°1_. c Pin one Owner s Name----- �U-, �:=:j - ""e!c�.+. � / Address---••--------•- Q_ ..... Contractor's Name-------._ __ Phone..____.__________________________ -- - ------ - Installation will serve: Residence [;0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms _ a- Number of baths ----I--- Lot size _ -- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam k Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No �fl New Construction: Yes L� No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is-available within 200 feet.} - "" - �1 Septic Tank: Distance from nearest well_Sd-_�____-DistaIn�ce from foundation_1�- --------.Mater al___________________________ __ _ No. of compartments----;L------------------Size.?�t-A_1"�---L ----Liquid depth--------- -------------Capacity.�_�_ ____-- -- I.t� Disposal Field: Distance from nearest welL�d--_--.-Distance from foundati n..--�-'�----------Distance to nearest lot line_-__�-.______.. Number of lines---_--------�--- -------.-Length of each line---:�©' s� - Width of trench. b_--:`�---------------- Number ------------••-- Type of filter materi - --Depth of filter material----j-----------------Total length--- _ _._ _____________________________ G Seepage Pit: Distance to nearest well_____________________Distance from foundation--_---.____-----_--.Distance to nearest lot line----------------- N ❑ Number of pits---------------------Lining material-------- -------Size: Diameter-----------------------Depth------ -------------------------- Cesspool: Distance from nearest well---------------_Distance from foundation-.------------------Lining material------.---------------------- als. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------- ...g Privy: Distance from nearest well-_----------------------------------------------Distance from nearest building--_----__.._..__-------------------------- ❑ Distance to nearest lot line ----------- --�-------------------------------------------------•--------------------- ------------------------ 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 reclulations of the San Joaquin Local Health District. ------------------------------------------------------------- -----------(Owner and/or Contractor] (Signed) ------------------------------------------------- By: -------- -- .. .�,. --- -- ---------- - By:--------------------------------------- (Plot ------------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE_ 7� - -- --------------------------- APPLICATION ACCEPTED BYr��_ REVIEWED BY------------------------ -- -- -------- ------•--------------------------•- DATE---•--------•-------• ----------------------------- ----- - ------------------- ---- --------------- ----- - BUILDING PERMIT ISSUED_----------------------------- _------------- DA Altera ons and/or recommen tions __."-"/� '- . --�-� ----------�--.__47 IX ---- -----------------------------------------------------" FINAL INSPECTION BY:. a " 't"�ffi --------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD.