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FOR OFFICE USE; ------------------ -------------------------------------- 9 APPLICATION FOR SANITATION PERMIT Permit No. ._� .._ __J--_ -- ------------------------------------------------------ {Complete in Duplicate) Date Issued .._... _ _/?1 y ------------------ 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 descr e .I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANR LOCATION.. r _; "k-_ __ _ -__________ G __,�-�-,r�� Owner's Name:------- -- -- --- ---------- -------------------------------------------------- ------------ --------- ---- Phone --- ..Address --------------------- - G1----••-------------------- ------------ ----------. ----- Contractor's Name-------------� r -- , •--•-• •----- Phone------------------------- Installation will serve: Residence [V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms ---t3_ Number of baths Lot size .____l__ ______________________-__.__._ 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: jlf 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----------------------- Disposa t �� Disposal field: Distance from nearest well_--.�,7pp_._.---Dis`anee from foundation_---�D----__.._-Distance to nearest lot I�e__ ____ ______ Number of lines_______-___/___p______________.___Length of each line-----------4-Q__.._____.__.Width of trench......... of filter material_-sl-_t__Xp - g _,---____De Depth of filter material----- length 4d---______________•-_--•.__-- N , Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material---_-------------------Size: Diameter.---------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- Lr ❑ 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):------------446Ge---------------------------------------------•---------------------•-------------------------------------------------------- -----------------------•--•---------------------------------------------------------------------------•-------•--... .......------------------------- --------- ---------------------•--------------------•----------- r __________________________________________________________________________________________________1_____-__________________--______________________-__----_____________.__.__-.________--__-----__.____.._._____---..._ 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) --------- dor Contractor By:---------- •--:` - -------------------v-------------- --(Title)------------------------------------------------- ---------- - - (Plot plan, showing size of lot, location of system to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______� '_ .-__ ____ DATE_ REVIEWEDBY--------------------------------------------- --------- -------------------- ----------------------------------------------- DATE------ --------------------- BUILDING PERMIT ISSUED--------------••---$_- __----------- -------------- ----------------------------------------------- DATE------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------- ------------------------------------------------------------------•----•-------•-------------------------------------------------------------------------------------------- -------------- - -------------------------------- -----------•-- -------------------------------------------------------- - - ------ ----- -----•-------------------------------------------------------- ------------------------------------ --------------------------------- FINAL ---------------- ---- -------- FINAL INSPECTION BY:_ - - - --- ---- - 1----•--------------- Dater ` 'C f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED 5-59 3m 3--63 i,p,CD.