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FOROFFICE U5E: -------------------------------------------------- qq�� ____________.___----------_--_____----_- ------- APPLICATION FOR SANITATION PERMIT Permit No. ._Cz�_.-_� Z--- --------------------------------------------- --- (Complete in Duplicate) Date Issued — This Permit Expires 1 Year From Date Issued dS'1- V Application is hereby made to f e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in com liance with County Ordinance No. 549. 19`70 t N- cu E,�e ' ' JOB ADDRESS AND LOCATION_' " Owner's Name----- i--------- V = r --------------- --- - ------------------------ --------- Phone---------------------------------- Address ;. 1 - ••; Contractor's Name-------- _...c _sl._F-. ---------------------------------•-•----------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ _Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __._f Number of bedrooms _-_V"Number f baths ___l__ Lot size ---- e ______ ---____ Water Supply: Public system ❑ Community system ❑ Private Depth t -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 ❑ 4" No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,I Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- El -____._______.._- ----______.______--________-❑ No. of compartments--------------------------Size--•-----------------------------Liquid depth----------- ---- ---------Capacity--•------- ------ Dispos Field: Distance from nearest well-------`�..P......Distance from foundation----!.A..........Distance to nearest lot line__r$ --------- Number of lines------------I------------------- Length of each line-------�"F_____.___.__. Width of trench----- ----------------------- Type of filter material__/21---------Depth of filter material------/__£_'.........Total length____�� _________________-___-._ SeenaAe Pit: Distance to nearest well- -jQa-`_.___Distance from foundation___J,0___' _._..Distance to nearest lot line__ _--__-.- Number of pits-----------f---------Lining material__1_S _t_---..Size: Diameter-------- -3 .- ----Depth...... -S`---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size: Diameter---------------------------------- Depth❑ p __.-----------_----------------Liquid Capacity __gals, Privy: Distance from nearest well _..------_--_.________________________________Distance from nearest building---.__.__.___________-__.___-___-_--- E ❑ Distance to nearest lot line------------------------------------- ------------V---------------------------------------- - _ . ------------------------------------------------- Remodelin9 and/or repairing describe):_ zee -------- [ ----- j- -+�D:p ------------------- -------------------------------------------------------------------------------------------- ,. ------------------------------------------------------------------------------•-------------------•----------------------------------•-------------------------------------------------------- --------- ------------------------------------------------------------------ 10' I hereby cer ' at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta law and rules and regulations of the San Joaquin Local.Health District. (Signed)-------- - ------------------- -------•------ - --------------------------- ----------�-,and/or Contractor) 0 BY: -xs s. - --=----- --- --------'- (Title By: plan, showing size of lot, location of sys+ m� in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR-DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY------Z-- ------------------------------------------ DATE__./.' -I -(a REVIEWEDBY--------------------------------------------------------- ---------------------------- ------------------------------------- DATE--------------------•--------' - BUILDINGPERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:---------- ------- -- - -- ---------------------------------------------------------------•------------------------------------------------------------------- -------•---------------------------- --------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: �y---- ----------- SAN ---------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CQ.