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FOR OFFICE USE: tj APPLICATION FOR SANITATION PERMIT Permit No. ./SY____ --- -------------------- ---------------- ---- --- -- (Complete in Duplicate) Date Issued ____ ___ 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. 4 This application is made I co li ce with County Ordinance _ 549. U 706 ADDRESS AND LOCATION---- ,—P----- -- ------ =IrC ',wr ------------- 1 f Owners Name = .... . -- ---- --------- .:.-. CC-� :�- Phone r ..Address__ /Y 7r w=�1.: --- -----'--- •-- -----------------------�---------------- -------------------- Contractor's ---------------Contractor's Name��t_�---�-�-`--`�--- -�=-- - - - ' �-��----- ----- ��-��"�--�--r------------------ Phone.i��__�.�-�T---- Installation will serve: Residence= partment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other Number of living units: ____ ___ Number of bedrooms -------- Number of baths _--)41&t size _�//-./� .______?�_____-� . ----- Water Supply: Public.system ❑ Community system El Private E] Depth to Water Table .Kpft. 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 D o ❑ FHA/VA: Yes ❑ No ❑ �3 TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ,_61-O Dist-anc-e•- from-f-au-n- a_nion____r �_____ Material____Lt ____f_-_-_-_-_-_=__-_____3__ _. _____ No. of cam artments_._ _ - Liquid de thCapacity--- _ - ---------- Dispoa � Field: Distance from nearest well__/&::�7. Distance from foundati n..-.l.Ch ____-Distance to nearest lot line:_ --'_'-___ 1 Number of lines- 1-.--_- Length of each line_____ ig._r_ Width of trench------- _______________ .� ------ Type of filter matenaL___�i4cM-i-----Depth of filter material-__, --------------Total length__�Q_______________________________ Seepage Pit: Distance to nearest well__N_ah_C--------Distance from foundation___-.1_;a_ ____.Dist nce to nearest lot f {{�� f, r ---------- Number of pits______________________Lining material__1-�d_�_.`______Size: Diameter__ p Cesspool: Distance from nearest well-----------------Distance from foundation_________-____-___.Lining material-------..----------_.__.___-_________- ❑ Size: Diameter----- ----- --------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------_.---- ❑ Distance to nearest lot line---------------------------- -------------- - -------------------------------- ------------------------------------------------ Remodeling and/or repairing (describe) ---- ,-- -- . -- ------- --- --- -- --------------------------- --- - -- ----- -- --- _ ----------------------------------1-- ------------------------------------------------------------------------------ ---------------------------------- ---- -------------------------------------- ------- -- hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------------------1--------- � ---- ----- ----------------------------Pwgr�/Or Contractor) - ' By:--------------------------------------------------------------------------------------� z------ e- ------------------(Title)------------------------- ----- (Plot plan, showing size of lot, location of system in relatio o wells, buildi s, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY..--------- - �r��--------------------------------------------------------- DATE �"_'j C?,j--------------------- BUILDING PERMIT ISSUED-------------4, ----- --- ------------- ------- -- ----- -- DATE -------1: ----------------------- ------ REVIEWED BY---------------- ---------------- DA ------------------------------------------------------------ AlMeusand/or r commenda 'on .ems----- a. ---------- --- ------- --= -- ------- --- ----= --��-•-------------------------------------------------------•----------------------------------------------------- - --- FINAL INSPECTION BY:.---- - -t -> —--------------------------- Date---- �=r�----------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stotktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISER EI-S9 3M 3-'63 F.P.CO.