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�f FOR OFFICE USE: _ v� s�------------------- -'3 ------------------------------------- -x,30---- APPLICATION FOR SANITATION PERMIT Permit o --------------------------------------------------------- (Complete in Duplicate) Date This Permit Expires 1 Year From Date Issued -31 Application is hereby made to the San Joaquin Local Health District for a permit f construct and install the work herein t d. This application is made in compliance with County Ord- e.No. 549. _ . rte � 7.7. JOB ADDRESS AND LOCATION_--JQr-_S�1YP-Q - l Y--- Owner's Name__ m� � �- - -------- ne_ Address----•-•---•-/A,2---- - --------------------------------------•--••----------•----------------------------------------------------------------------------------- Contractor's Name---------- --------------------------------------------------------------•----------------------- Phone-----. ---------- ---------- Installation -Installation will serve: Residence [g-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms ,V_ Number of baths _ --- Lot size _f�_Q_-�-__��Q_�________________________ Water Supply: Public system C] Community system E-1Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [ lay Loam [:] . Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ®/ New Construction:` Yes ZJOIN-o ❑ FNA/VA: Yes 940''No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / ,p ,'�_� Septic Tank: Distance from nearest well__� _�___Distance .from foundation---lQ_-_____.Material_.�-(,�t 6/ ___` "•` -------- -W �No. of compartments-_-A_ Siz�Z�� e ---Liquid depth-----��------------ Capacity--��®_------ Disposal to nearest lot line__��___ --___- Disposal Field: Distance from nearest well._��___-_Distance from foundafii n__ ___ Number of lines_______._.-`____ _______ Length of each (ine___5z9e—____��____-Width of trench.-W---- - rench.--r2 Type of filter material- Depth of filter material_--� ____-_-Total length___.� 1 ___.____________________ Seepage Pit: Distance to nearest well.---------------------Distance from foundation--------------------Distance to nearest lot line_____________-__ ___-_Linin material______________________Size: Diameter_____--_------.-----__ ❑ Number of pits.- -• - - 9 l}eptn--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-------------------------------------- ' ❑ Size: Diameter--------------------------------------Depth---------------z------------------------------------ ----------- --------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----------------------------------------- A ❑ `' Distance to nearest lot line----------------------------------- !' Remodeling and/or,repairing (describe] ------ ----------------------------- 11 -------------------------=-----------W N ----------------------------------- ----------------------------- --------------------------------------••---------------------------------------•-----------------------------------•----------------------------------- 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)------ ---- ------ - ----------- ------------------ --------------------- ------------------:�or Contractor) By:------------------------------------------------------------------- ---- - --------------(Title)------ °` - - -------------- (Plot plan, showing size of lot; location of system ' elation ir we Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ --- - ----------------------------------------------------------- DATE------- - REVIEWEDBY---------------------------------------------------- ----- ------------------------------------------------------------------ DATE------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- --------------------------------------------------------------- DATE------------------------------------------------------------- Alteraiions and/or recommendations------ ------ -----------------------------------------------------------------------------------------------••-------•--------------------- ---------------- ----- ----------------- --------•----------------------------------------------------------------------------------------------- -------------------------------•- ------------------------------------ --------- -------•----------------------------------•------ - -•-------•------------------- ----- ------------------••------------------------------ ----------------- -- ------------------------------------------- ------- I y � /_ F FINAL INSPECTION Qate - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3--63 F.P.Ca.