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FpR OFFICE USE: -__;-•.- �-r_r� ----------------�i_�` c?___- APPLICATION FOR SANITATION PERMIT Permit No. ._-r .�- 3 ------- --------------------------------------------- --- (Complete in Duplicate) r Date Issued ..._ .�7 --------------------------------------- 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- , � -- x Ordinance „9 IfT��, JOB ADDRESS AND '-!?�-.__ --- �!* ---- s: Owner's Name - e ---------------------------- Address-. -------------------------- Phone. j- � Address................. 1 Contractor's Name------------- - ,---L_-_.. ___- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _,5._ Number of baths -_r5-_ 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-----------.--------I 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 ---Distance from foundation_ .-^-___.Material------ t61[ ___________________ No. of compartments__.:_._. dP-a_..___.___Liquid de th Size______ _ -----------------------Capacity 1------- -------- Disposal Field: Distance from nearest well_./!i0_Distance from foundation--- Is7__._::...Distance to nearest lot line_._.1!6�..._____ g f _.Width of trench -------------------- 1"J Number of lines.:______,l____._._ ..r_Length of each line_____ Type of filter material, +�r----_-Depth of filter material....f-f ________._Total length___._.__.3_Q_____________________ Seepage Pit: Distance to nearest well------ __Distance from fou dation_-��d_L-_Distance to nearest lot Number of pits._..___-�------____Lining materi -�__ � Size: DiamEter------..59.4,------------Dept h----.I.5`------------------- Cesspool: Distance from nearest well---.-------------Distance from foundation___.________:__:`:.Lining material___.__..____.._____.________________ I Size: Diameter----=---=----- ----De th---------------------- --------------------------t-Li uid Capacity gals. Privy: Distance from nearest well___---------_----------------_-------------------Distance from nearest building__.__._._..____________.________._._.--... ❑ Distance to nearest lot line-------------------------- -- -------- ------------------------------------------------------=-------------------------�------------ I 17 4 172- Remodeling and/or repairing [describe: _ t”' --- __ ___Y--_- --- -------------------------------------------------------------- -----------------------y-------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------ ------------------- 1 �------------------------ - ----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, and rules and regulations of the San Joaquin Local Health District. i (Si ned 9 )--------- ---- ------------- v -� ------------ ------------ - ------ ------------------------------- - ----- --------(Owner and/.or Contractor) By'-------. -��- �--... .i-- ------ -- ---- ------- (Title) � ' .(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 ` APPLICATION ACCEPTED BY +�' ---------------- DATE 3a!7 --------------------- REVI - -------------- REVIEWEDBY.------------------------ 1.7_4 ------------ --•-------------------- DATE-------------------------------------------------- BUILDING ----------------------------- - - - BUILDINGPERMIT ISSUED---------------t----------------------------------------------------------------------- ----------- DATE---------------------- ----------------•------------ ------ Alterat' ns and/or r commen ations:---------- ------ ------- ' -----=----- - ---- ---- - ----------------------- - ------------------------------------------------ �'� ----------------------- ------------------ ------------------------------- -- ----- ------ ---------- ------------------------------ --------� -- ---------------------------------- ------------------------------------- ---- ------- --- --------- ------------------------ FINAL INSPECTION BY:..� =_._f ------------------ Date. ------------------------------- � -�--� - �f------. . 5AN`JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124-Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California f r.P.0 4.