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-------------------------------------------------- ---------- --------- --------------------------------_.- APPLICATION FOR SANITATION PERMIT Permit No. ------ ------------------------------- ----------------- = (Complete in Duplicate) -------------- This Permit Ex ices ] Year From D06-Issued - / Date Issued __111.4�3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and the w i This application•is made in compliance with County Ordinance No. 549. ^• .• a ork herein described. : -,tJ•'-{ate,-k�,i,� c JOB A13DRESS AND D LOCAfION,�41 ,d. = � ua�s� ---- F r __�--Owner's Name------- _ ---------•-••----------- Address--------------- t ------------------------- ----- - Phone -- . ._.. f_o------ Contractor's Name_- -----..----- �.3-3:3Zv - Installation will serve: Residencers'" Phone________________________ Apartment House ❑ Commercial ❑ Trailer °Court ❑ Motel Other 0 Number of living units: J----- Number of bedrooms __ f O___ Number of baths - -_-_ Lot size Water Supply: P4blls�s, atem� � Y � Community system ❑ Private 41 Depth to Water Table 7.n ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam A Clay [I Adobe H Previous Application Made: (If yes,date--------------- ❑ ardpan 1 No New Construction: Yes 4 No ElFHA/VA: Yes ❑ No E]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_ �_ Dista ce from foundation__-_ Q--------Material___..____- No. of compartments_-_:a-_- -- _-_Size �� /p 6 ��(r r �� + quid depth r Capacity_.1 4.�_._- Disposal Field: Distance from nearest well-, --_-_-_ r Distance from foundation----- --__-___--Distance to nearest lot line__s�_--_____•__- Number of lines--_:_ ........-- ------------ 'Length of each fine____ Type of-filter materia Width of trench--- filter� - _Depth of filter material___} -_ --------_Total length_tJ-'f1 0 h Seepage Pit: Dito nearesfi well._- U"D ----------------------------------- stance rpj -------_Distance from oundation__I- ---------Distance to nearest lot line----------- Cesspool: I_f_••-.-. fes' Number of pits._------------ Lirirn material- --_- _ - - •} = g --__.-Size: Diameter----3.r_-'" 'J Cess ool: ;. � - ----- --------Depth_.�>r_---'--- ----- ------ �� d p Distance from nearest well----------------- Distance from foundation_ ________________Lining material_-------------------------- F ❑ Siie: Diameter.----'------- -----------.Depth---------------------------------------------------- -•--•----- ' ' Liquid Capacity----------------- Privy:. Distance from newest well---------------------------------------------- gals. } __--_-_Distance from nearest buildin Distance to nearest lot fine__.---'---------------------- 9-----------________---_____-------- -. ----------------------------------------•-- Remodeling and/or repairing (describe):-------- _---------------------------------- ----------------- -------- -----•------------------------•--:-- ------------------------------------------------------------------:--------------- ------ -j ------------------------------------------•-----------------------------------•----------•----------------------------------------------------------•-------- h -- -----------••---------------------- — I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin Count t ordinance;, State_laws. and rules and regulations of the San Joaquin Local Health District, y a (Signed)-------6 " _---___(Owner and/or Contractor) ------------- I (Title)------------------ ----------------------- ' (Plot plan, showing size of,lot, location of system in relation fo wells, buildings, etc.,can be placed on reverse side). ; I' FOR DEPARTMENT USE ONLY I ; APPLICATION ACCEPTED BY... REVIEWED BY ft --------•- - DATE---1j_— c __ - ----------------------- ------------ - --------------- DATE------ ------------------- BUILDING PERMIT ISSUED------------------------------- - - ------ �----' -------- �- -------------- ----- ----------------------------------------- DA•TE.---------- aerations and/or recommendations: _..__.- -- --------- -------------- -•-------------- ------------------ ' --------- -------- r.r _ FINAL INSPECTION BY:-. . .......... _. ' ----- -------------------- Date_W'_r r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,California ES 9 REVISED B-$9 3M 3-'63 F.P.Cq. Tracy,California I