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FOR OFFICE USE: ---------------- ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------- (Complete in Duplicate) tf/trrdr`�d Date IssuedS/Z4/4 3 --------------------------------------------------------- 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCI------ t�l�_�- -•P ---.._------------- Owner's Name_(.�1 -- -•- _ Phone---------------------- ---- Address--------------•---------- -----z-t---------- '- i`-.'-`e------------ ------------------.---------------------------- Contractor's Name--- --- .- ---------/-- Phone •------------------------------------------- -------•-----------•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [ � � Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ----------------------______________________________________ 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 E] Clay E] Adobe C] Hardpan F] 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__.5�_..___Dist fc ufrom foundation-------fQ-____-_.Material----- _ _____________________---'..__---___. I Ir p3--------------Size�'�_.X--If_114S---Liquid depth------ ----------- P Y V------------- r No. of compartments Ca ace# .e _ � Disposal Field: Distance from nearest well_.•F�..--__Distance from foundation.__ 1_49_1__._Distance to nearest lot line.-_ �_____ Number of lines------- _ __- Length of each line______ O__�___._____._.Width of trench �_'---------------------- g Type of filter material__��______Depth of filter material_____.f f :_____._Total length____�_� ------------------------_ M Seepage Pit: Distance to nearest well------ -------------Distance from foundation---.-.-..............Distance to nearest lot line_______._______._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----.------------------.-------- V ' Cesspool: Distance from nearest well_________________Distance from foundation....--------__ -, Lining material_._.____--.-____________._____-_____ ❑ Size: Diame#er--------------------------------------Depth----------------------------------------------------Liquid Capacity--- ------------------------gals. Privy: Distancefrom nearest well--------------------------------------_-----------Distance from nearest building.---------_---_----_________.___.---_-. 9 ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------- ---------------•-- •-------- -----------•------------------------------------------------------------------------------•-•-----•---_-_-.--••------•-----------•---------------••-----------•------------------------------------------------ Y' ------------------------------------------ --------•-------- ------------------------------------- •-------------------------------------------------------------•----------------------------•------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and ruI s and regulations of the San Joaquin Local Health District. (Signed)------�� _ 4 c ------------------------------------------------------------ vner.and/or Contractor]BY� - - (Title) --- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED !f----------------------------------------------------------- DATE-t.1,2n-��- REVIEWEDBY------------------------- ----- ------------ ---- ---------------- ---- ---- ----------------------•----------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ------------------------------------------------------ Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------•------------ -------------------------------•- ------------------•------------------------------------------------------------------------------------------ -------------------------------------------------------•--.--•--------------- ---------------------•----------------- ---- •------------------------------ ------------------- ---------------- --------------------------------- ---------------------------------------------------------- ---------- -------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I --------•--•-----------------------------------•-----------•-------•------------------------------------------------------------------------------------------------------------------------------- -------- ..--------------- FINAL INSPECTION --------------------- Date. -—_ -f---. - -�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelion Ava. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO.