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r-OR OFFICE-USE: ----------------------------- - ------ APPLICATION FOR SANITATION PERMIT Permit No. _ZU 7_._. --------- (Complete in Duplicate) d i " Date Issued __-- �-.--6-�---. ------------------ This Permit Expires_1 Year From Date .Issued , ' Application is hereby made to the San Joaquin Local Health District for a permit to co t-and install the work herein described. This application is made in compliance with County Ordinance No. 549. V � c r T --77 - JOB ADDRESS AND CATION_.� _!-__�----- ---•_"_---•- Owner's Name _ -• • --------------- --•- --- ---- ------ Phone------------------------- Address. T !+~. -` "--- - ----- ------- I----------------------------------------------------------- � Contractor's Name--- - - --------- -------- .. ------------- ---------- - ------------------------ Phone----------------------------------- t. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ • Other ❑ Number of living units: _� __ Number of baths __ _____. _____ Number of bedrooms ___ � Lotsize __"- -�__ ...t..,"______________________"._ Water Supply: Public system ❑ Community system [!r Private Q Depth t Water Table -------- ft. ; Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [Clay Loam [3Clay E] Adobe E] Hardpan ❑ ' t . Previous Application Made: (if yes,date_..________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes E] No [ ; TYPE OF INSTALLATION AND SPECIFICATIONS: r 5 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e Septic Tank: Distance from nearest well------ ----------Distance from foundation---------------------Material---------------------------._..___--_..__.____._. i ❑ No. of compartments--------------------------Size--------------------------------Liquid clepth--------------------------Capacity------------.----------- Disposal Field: Distance'frorri neardst'well—"_' ''__ -Distance from foundation----I.P__'.._..Distance to nearest lot line_•----- [ Number of linesE__.____o?r------------- Length of each line--------j ----__--__-_-_-Width of trench--- __,__________.________ Type of filter material----r =_ __ ._...__Depth of filter material_"______ _______Total length___. .a___ __________________________ ' zif �a Distance to nearest well______�__._______Distance from foundation-------j_D/__.Distance to nearest lot line__.'S�-___ ❑ Number of pits--------/------------Lining material__--- _ ------,Size: r_ --X_1CDepth -o__-------------------- I Cesspool: Distance from nearest well-------_---------Distance from foundation- ------Lining material__..____-___.________-__.______.__. ❑ Size: Diameter---------- ---------------------------Depth-------------------•------.--------------------=-----Liquid Capacity- ------gals. 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.___-_-__.____-_.---_.______________-__._. ❑ Distance to nearest lot line-----------------------------------------------------------------------•---------------------------------------------------------------------- Remodelingand/or repairing (4!! ibe) ---`--------------------------------------------------------------------------------------------------•-----------------•------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------•- ----------- -------------------------------------------------------------------------------------------•------------------------------------------•--- ._. ------------------ I hereby certify that I have prepared this application and that the work will be- done in accordance with San Joaquin.. ounty ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. (Signed) --------------------------------------- ---------------- -- c r Contractor) - y. r (Title)--- - (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). EOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_, '- -------------------------------------------------- DATE--t(--------- -7 --------------------------- REVIEWEDBY------------------------------------------------------------------------------------------.--------------------------------._ DATE BUILDING PERMIT ISSUED -------------------------------------- DATE-------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------•---•-------•---------- ------------------------------------ -------------------------------------------------------- ------- --- -------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:_" *?--t -------------- Date--L�- `�4 ------ -- ------ "----------------------- :e SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Tracy,California Stockton,California Manteca,California ES 9 REVISED a-59 3M 3-'63 P.R-C O. - Aa