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FOR OFFICE USE: ^• J. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ -------------------- . (Complete in Duplicate) ------ This Permit Expires 1 Year From Date Issued Date Issued .. .�.3 7 fApplication 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. l JOB ADDRESS AND LOCATION.--._ - •»$ --------- -----------4. --------- ------- Owne'r's Narrme.._, _----•- --------------------" _ ,� � - ¢ •-----•-••------••---•------------------ ------------------------------- ------ Phone-------------•-- - :..--•-------•--- Address -••---.... --- ""1 ---------•- Contractor's Name.- ----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer G4".;y Motel ❑ Other ❑ Number of living units: _�.__- Number of bedrooms _-Z Number of baths .. .._ Lot'size ------- r Water Supply: Public'system ElCommunity system El Private [ " Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam'`❑ .,-Clay [X Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------.------..j No Lao,' New Construction: Yes ❑ 1 No [;J� 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_.,�.6� ' Qistance from foundation..- �'__-__.Material..- +' r . No. of compartments------ - 42 4- /---Liquid depth---„-. ' Ca'acit ----------------------- i Disposal Field: Distance from nearest weft-_ '-_:Qistance from foundati6n._A40_ .:�._-Distance to nearest lot`line--------------- I � Number of lines---------2--_------------------Length of each line------ . --------------Width .of trench---- `�f--------------------- Seepage Pit: . 'Distance to nearest wellj_420 -Distance from foundation_,&Q Y-._-..Distande o• nearestlot f r Type of filter material-- !*?4C.4 ___Detth of filter material___.,?_-` ..._.-total length -------------------- ------Linin material._.�0_4r'n C..Size: Diameter- .X- -a-.-_•_Qept'r,___-/ ------------- ----- Number of pits_.....,..-- g, . Cesspool: Distance from .nearest well----------------- from foundation.............: Lining'Pmaterial____-._..----------------- _ ._-... 0 ❑. Size: Diameter--- ----------------------- Depth -__-- :--Liquid Capacity ' gals. - "'' .: • Privy: Distance.from nearest 'well- --------------------------------- Distance from nearest buildin� '�-L g ------ ❑ Distance to nearest lot lire------------ -------------------------------- d t V ------------------------------------------------------- TTI --� -------- --------------------- Remodeling.and/or repairing (describe):---- 1 .� rn _-- ---------------------------- -------- -- = - = ------ - ------- t ... - --------- --------------- -------------------------------•--------------- -- •-------------------- •--- ::..---------------------------------------- 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. I .. ---- ,, �` w " -------- ' fir'` ' ` (Signed],- - -- - - -� - �-.. � .�`"� �------- ------------------------(Owner and/or Contractor] By:_ � . ._ . -- .err -------------=---------------(T'itle}--------� 0-0_0----- __.___---------------______ __ (Plot Ian, showin size o ot, location o st' P g em in relation to'Wells. building's, etc., can. be placed 'on reverse.side). ! FOR DEPARTMENT USE ONLY T+ APPLICATION ACCEPTED BY ----------------------------------------- DATE ---- -- - -- -. REVIEWEDBY -=---- ----- - -------------------.'-- --------------------------------------------- DATE - = BUILDING PERMIT ISSUED:= ------- — DATE= +� A terations and/or recommendations:......-- s s k ; ------'---- ------------------ ------ ---•--------------•------------------------ --------------- --------------- ---------------------------------:--_.__.--._-... ...e ....................-------------------------- --.._...---_-........-.-------------------------..- - S FINAL INSPECTION BY: Date-------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F,P.CO. -