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FOR OFFICE USE: ------------------- --------------------------- ------------------_____________________________ __ ___-------.---------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the'San Joaquin Local Healfh District for a permit to construct and install the work heWn described. This application is made in compliancewith County Ordinance No. 549. JOB ADDRESS AND OCATIOJ. • _47 - _461 Owner's Owner's Name_ - a - /. - ----- --. Phone_��f C� _ �!'. Address----0• - °[`7 Jam '6 `' ti. - --- -------------- -------------------- Contractor's Name -- ...` =- - f f.� �• - -------- ------------------------ Phone. ------------------ Installation will serve: Residence V(Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._.--- Number of bedrooms_-- Number o baths __f___ Lot size k - �•'� Water Supply: Public system ❑, Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a rdepth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: -(If yes,date____________________} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE'OF INSTALLATION AND -SPECIFICATIONS: - f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) yrv � Septic ank: Distance from nearest well--- /---'Distance from foundation /0 _._ Material__ itNo. of compartments-__.-.� S/ Liquid depth_ --C---a---p--a-c--i-t_y �_---a-,_-------- ------ - Disposwell--n-We Field:, Distance from nearest well �Q --- Distance from foundation___-_f____.Distance to nearest lot line ------------- Number �____.__-_- Number of lines-----�__rr�� Length of each line____- S �f7 9 Width of trench -------------------- Type.of filter material____-1jt[�__�_...._Depth of filter material___._��.---------Total length____ ------------------------------- Seepage Pit: I Distance to nearest well-------_---------------Distance from foundation____-_____......._..Distance to nearest lot line______.________. (� ❑ Number of pits__------------------Lining material--------_- ------------Size: Diameter------- ----------Dept h--------------------- ------------ Cesspool: Distance from nearest well------------------Distance from foundation---------------__Lining material--------.________________._ ❑ Size: Diameter----------------------- --------------De th------------------------------------------ ----Liquid Capacity- ------------------- - gals. Privy: Distance from nearest ke11-------------------------------------------------Distance from nearest building__ ❑ Distance to''nearest lot 'line-------- ` Remodeling and/or repairin I descr Vie.:, 3�.�_ _ __ -;--------- =�Pr ------: g � -- -------------------------- --- --------- - .r _ ----------------- _______ ______.-_..__________________--_„___r--___________-_____-_ ---------------- _ ___________________________-------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ___ ______________________________________________________________________________________________________________________________________________________________________ ___________ 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 nd rules and regulations of the-San Joaquin Local_ Health District. r „ Stne -----4 _ ________________________________ _ ----------------- ------------------ By:---. _______________ I3 ' ` ----- _ r I ... ;.:.. �o� Contract r .._ ,,. on ar Y• r-- ---------------------- (Ti+e) - (Plot plan, showing size of lot, location of n re( t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. ___-_.`K-- - - -- ---------------------•---- - ------------- --------------------- DATE--�1"��---"-�- —----------------------------- REVIEWED BY-------------------------------- ------------ -----. _ DATE.. PERMI- •• - -----------------------------BUILDING ------ T ISSUED --------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:.-------------------- ----------------------- --------------=-------------- ----------------------------------------- - k --------------------------------------------------------•-------------------- ------------------------------------------ - I a-------------------------•---------------------- ---------=- ------- b --------- -------------------- ------------ -- -•------.--------------- FINAL INSPECTION BY:- - Date---- t r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3--63 F.P.CD. .