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FOR OFFICE USE: ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..f-1�Z......� --------------------------- -------------------------- (Complete in Duplicate) Date Issued ___�__l_� Permit Application is hereby made to the San Joaquin Local Health District oroae Issued perm It to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--'g-.-- N'!r'"''"'. !f -- -------- Li 1 .. ------------------ Owner's Name------- -M---- - -- -- ----------------------------------- Phone------------------------------------ Address - -- -- ---- t t ------------- --------------•---- Contractor's Name------------ - - --- - r- - ------------ _ ---------------------------------------------------------- Phone------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [:] ❑ Other Number of living units: __-. _ Number of bedrooms._ Number baths _/`__ Lot size ____ y -..______------ Water Supply: Public system C1 Community system [:] Private j[ Depth to ater 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--------------------) 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------------------------------------------------- ❑ No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- Dispo Field: Distance from nearest well---A�p......Distance from foundation__L_e___T._____-Distance to nearest lot line__j=__-_____._ Number of lines------------1--------__-----------Length of each line------>o_aG_'------- Width of french------ f-.------------_--- Type of filter material__._�R-------Depth of filter material____. length------I---O-4 _______________________ Seepage Pit: Distance to nearest well------------ -----.___Distance from foundation___________________Distance to nearest lot line-----------.---- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: D-stance from nearest we€€------_----------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)------------- ----------------------------------------------------------------------------------------------------------------------------- A - ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regulations of the San Joaquin Local Health District. (Signed)---------------•----- ------ --- --- -- ------ -------- ---- ------------------------------------------------------------------------------------ rand/or Contractor) fb Sy:------ ------- -- -----�------------- (Title) (Plot plan, showing size of lot, location of system in relyoil n to wells, buildings, etc., can be placed on reverse side). O FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.;:Ir": _ _` r ----------------------- --------------- ----------------------- DATE-----~� �6.fr - -------------------------------- REVIEWEDBY------------------------------------------------------------------- --------------------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations------- ---------- - -------------------------- -------------------------------------------------------------------------------•-- -------------- -------------------------------------------------------------------------------- ----------------------------------------------------------------------------•--------- -----------------•------------------- FINAL INSPECTION BY:.,------ rip-,'. ---------- ------------ Da#e__.7/ ------`------------ ---------------------------------- --------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltcn Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t ��=�fi 9 F!EVISEO 8-59 3M 3-'63