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t7ROFFICE USE: -------------------=------------------------------- .QR.rz2. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ � ---------------------- ----------------------------- - (Complete in Duplicate) S` –" ---------------- ------ This Permit Expires 1 Year From Date Issued 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._Z�,e�--�r�. ---�-�----. ----- - - - -�' -------------------------------••---------------------------------- Owner's Name---------- -- -- ---;.. '&7�+ �°-- -------------------------- -------------------- Phone----------------------------------- Address ------- --- 16 . .... ------------- --------------------------------------•---------------------•----------- Contractor's Name--------.... ---'----•------------------- ----------------------------------------------------------- Phone----- -----------------_--------- Installation --..-------------•---Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑- ' Number of living units: _-__ Number of bedrooms -0.- Number of baths . _ Lot size .�-- �---------------------- Water Supply: Public system ❑ Community system ❑ Private Gk/Uepth to Water Table c5V_ft. Character of sail to a depth of 3 feet: 'Sand E❑ Gravel ❑ Sandy Loam [:] Clay Loam ElClay ❑ Adobe[ ardpan ❑ Previous Application Made: (If yes,date--------------------) No � New Construction: Yes R5--NoE] FHA/VA: Yes 2;1-- No El (�; ' TYPE OF INSTALLATION AND SPECIFICATIONS: �yA3 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J v` Septic Tank: Distance from nearest well-_+0-14. -----Distance f om foundation_-.�ie�----------Material No. of compartments .-.______-/Size -__-_._-_jVX_*'?Liquid d pth-4 f_/___ -------:Capacity�,�r�1 - _ Disposal Field: Distance from .nearest well.... it ___-Distance from foundation_a`_..-_____..Distance to nearest lot M/' ,�---__ Length of each line___ ___ i Number of lines--____-- - .��----------------Width of trench..�r----------------------------- Type of filter material c Depth of filter material--- �� ------Total length_1%j74__�_----__ 11 Seepage Pit: Distance to nearest well---/.&Z9_-_-_Distance fi:w foundation-/-X/,?-_Distance to nearest lot line__,_1e____._ ti 'i Number of pits....��---------------Lining materiaSize: Diameters&&R-rT._-.-_---__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------.--------.-...____-___------- ❑ "' Size:'Dibmeter--------------------------------------Depth------------------------- --------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well ------------------------------------=--------_ --Distance from nearest building-----------------------------------____._. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------- --------------------------------------------- Remodeling and/or, repairing-(describe):----------- ,-------- "� s 4°-�?�---•-n--------------- �---------------- --------------------- ------'---------------------- ---------------------------------------•-------------------------------------•-------------•----------------- --- –f ------------ --------------- ------------------------•------------------------------- r 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 regulations of the San Joaquin Local Health District. (Signed)------------------ ---- ..- ----�'G?'ip Ze,--------- -------------------- - ---- ------- ------------------------------- ---. { Contractor) _ By:--------------------------------•----------------------------------- � -- - y--------------(Title)- �f�'t� �---------------- ---- (Plot plan, showing size of lot, location of system in; ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- -------------------------------------------- DATE ` Ar C' ----- --------------- - REVIEWEDBY-------------------------------------------------------------- - ------------------------ DATE-------- ----------------- BUILDING PERMIT ISSUED---------------------------------------------------------- --------- ----------- DATE. Alterationsand/or recomm ations:- -- --------------------------------------- --------------------------------------------------------------- ----------- .�� j-� - �. ------- -------- -------------------- FINAL &SPECTION 13Y. ----- DateL.- �j ------ ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California 99 9 REVI6Eo 8-59 3M 3-'63 F.P.CO. k