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FOR OFFICE USE: — "* a _._,____• APPLICATION FOR- SANITATION PERMIT Permit No. - - x s Permit EComplete in s 1 YearF-------------- romIssued Date Issued ------x ----- ----- Expires Applicafiion is he by made rto 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.A LOCATION_'_(i1_ -- '� --- _"___-- 1 �i Owner's Name--------- - --------4.2 c --------------------------------- Phone---.--'------------------------------- Address------ -----•-----------Address-----. # s. ..-• .. -- ----- - ----------------------------------------------=--------•------•------•---------------- Contractor's Name-----`r' r =--------------•- •-------•-•-------- Phone..-•-----_----------- .-------- Installation will serve: Residence [21 { ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living _ _ Number of bedrooms units: __I�',. r 44-,-.Number of baths Lot size ----�'^----------- ---- ---------------------------- Water ---• - -----=--------- 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 [ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,'date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ................Distance from foundation--------------------Material-----.--------------------------------- y.❑ No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity--•-------------------- . Disposal Field: Distance from nearest weEl----- Distance from foundation..__.-Z�____.._.Distance to nearest lot line----- ........... ® � y � � Number of lines______________f _ Length of each line_____19�_1-----------Width of trench---;�-_�_____________.____.____ See a e Pit: Distance to nearest well------------- -.-''-_Depth of„filter material----.-fg� �___ Total length---,�_�_�'------------------------------- Seepage _j_______________________ Type of fit#er material_,�C[;___ _._____ P .g _=Distance from foundation-------------I-----Distance to nearest lot line______________.._ El Number of pits----------------------Lining material----------------------.Size: Diameter-------_----------------Depth-------------------------------- i Cesspool: Distance from nearest wekl----_------------Distance from foundation--------------__-----Lining material___.__.______..___.____.____________ ❑ Size: Diameter-------------------------------------"Depth--------------------------------_--------------, Liquid'Capacit ;---------------------------gals. Privy:. Distance from:nearest.well-------------------------------------------------Distance.from.nearest,building____4______._______________::._._-_-_. Distance 'to nearest lot line------------------------------------ - ------------------------I--- tfl t i ----------------------- ---------- Remodeling and/or repairing (decribe)---------------------------i--------------------------------------------------------- ------- ---- --------------------------------------- ----------- -- -----------------• -------- --=-----••:-------••------------------------------------- ----------•----- ----- --------------= ------------------- --------------- --------------------------------------------- --------------------- --------------------- -------- ------------•-------- -----=-------------•-----=------•------•----------------------------------=------ -- ----------------------------•-------------------------- 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. (Signed)---- = ------- -------- �lz'.` ----------------------------------------(©wrenand/or Contractor) ".._..... ------ ..-...... -------- --- - (Title) ' Bye=----------- - - - - - ----------------------------------------------------------------- (Plot --- --------------------.....----- --- -- ------- (Plot plan, showing size of lot, location of system in relatio�wells, buildings, etc., can be placed on reverse side). R. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__r!. ? rr -------------------------------------------------------- DATE_--- 3`0-- -------------------------------- REVIEWEDBY------------------------------------------------------------------------------- - ---------- ----•-------------------- DATE------------------•------ •------------------•-•----- -d BUILDINGPERMIT ISSUED----------- -•-----------------------------=------------------------------ -----------------------• DATE------------------------------ ------------------=---------- Alterations and/or recommendations:.------ ................... ----------------••-----•------•---------------------------------...--------•----------------------------------- --------------------------------------------------•-•-•-- ---------------------------------•------------------------------------------------------------.....----------------------1__---------------------------- .----•------------------------ ------------ -------------------- ---------- ----------- --- ---------------------------------------------------•-•---------------------------------------------- ------------------------- :1 t --- -----------------------------•------------ ----------------- -----------•--------------------------------------•-----•- -----•----------------------------------------------•------------- ------------------------- FINAL' INSPECTION BY%' Date " ��' . -- -- - ------------------------------------------------------ SAN -- ----------------------- I 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. 1 '. .14