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FOR OFFICE USE: --------------- ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- -------------------------------------------- -------------------- ----- ----------- ------- (Complete in Duplicate) -------- --------------------------------------------a This Permit Expires I Year From Date issued Date Issued � work herein described. is hereby made to the San Joaquin Local Health District for a permit to construct and install the w -t This tion is made in compliance with County Ordinance No. 549. J 0 ESS AND LOCA, 0 -----ZOAA------------ 7.......... Owner`s Nam -------— - -------------------r------ --------------- =---------- --- ----------------------- -------- Phone--•- ------ ------------- Address-------- ------------------------------------------------------------------------------------------ ij - --------- ---- . . m 4 - 1- ------------------------- Conf Contractor's Name-------- --- --- --------------- Phone..--•-------_---- ---------- Installation will serve: Residence Apar ent House I-] Commercial [:] Trailer-Court E] Motel ther E] J, ___�_!______________ ---------------- of living units: ---- Number of bedrooms A---- Number of baths J--- Lot size ------- Water Supply: Public,system,[] Community system El Private Eg' Depth to Water Table------- - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam 0 Clay Loam e Clay E) Adobe❑ Hardpan F1 Previous Application Made: (if yes,date--.--------7--------) No M New Construction: Yes 0 No ❑ FHA/VA: Yes D No [I TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank'orcesspool permitted if public sewer is available within 200 feet.) Z_ SeptTank: Distance from nearest well-_-P4 _1---Distance from foundation--/-C?--- ------Material_____02071dag--- -------------- p ' " 'V 57'---Liq-id depth--M--r-----------------Capacity No. of compartments........? -----------Size-0--X _1-------- Disp7l/Field: Distance from nearest well-_-5*7------Distance from foundation_____1Q_________-Distance to nearest lot lineY-j----------- Length of ea _ line----- Yip -------.--.Widfk of french------ -------------- dr Number of lines._------------- -------- T,t;-1,-length__.._____ ---------------------- Type l'"'Depth'I5th'6f . riTaf&i5l:=-------------- o a Seepage Pit: Distance to nearest well--------------------- Distance from foundation-------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material------------------------Size: Diameter------------------- ----Depth---------------------------------- Cesspool: Distance from nearest Distance from foundation__.,_- ______-___..Lining rnaterial------------------------------------ b ---_-------------------gals. 171 Size: Diameter---------------- -----------------------------Depth------------------------------------------------- ---Liquid Capacity-.. "j building-_____________________ Qistance Privy. Distance from nearest wel�------------------------------ ance from .'nearesf building--------- ------------------Dist< 1 1 - ----- El D ista n ce to nearest lot line------------- -`- ------------------------------------------------------ -------------------------------------------------------- ----- ------- Z--------- . ... ...... -------- ------ ---- ---------------------------------------------------------------- .. -------------------------- ------..------------•----------------------------------------------------------------------------------------------------------------------- ---------------------------------- ----------------------------- ------------------------------------------------------------r------------------------------ ------------------------------------------------- --------------------------:--------- I hereby certify that I have prepared this applicati on and that the work will be done in accordance with San Joaquin County San Joaquin ordinahies,.Stp"ws: and rules and regul ions of the San Joaquin Local'Health District. " ..... - -- ----- - ------ - ... .. (Si4ned)-------- -------------=;R_qW__W1r..Pnd/or Contractor) ------------------------------------ -------------- ------- -- - Plot --- --------6'- ------ ------- ----------------------------------------------------------------(T 0 i"i 4i � we (Plot plan, showing sizelof lot, location '.in relati o wells,,buildings etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------------- --------------------------------------- DATE-- 17-5� —-------------------- REVIEWEDBY-------------------------------- ----------------------------------------=--------- -'-----------------)--------------------- DATE--- -------------------------------------------------------- ----------——---------------------------------- BUILDING PERMIT ISSUED--------------------------------------------I-------------- ----------I- `--------------- DATE___J Alterations and/or nd/or—rec-ommendaiion$'- -�--'I;?, - --. ,- --- - - --- ------ --- ------ -------------------------------------- - ----------------------------------- -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ------•----------------------------- ---------- --------------=__�__-__:-----------------I---------------------------- ---------------------------- ------------m----------- ----------------------A---------------- -------------------------------------------------------------------------------------------------- I ---------------------------------------------------- - ----------------------:----------------- --------------------------------------------- --------- ---------------------- ------------7----------------------------- FINAL INSPECTION BY: --------------------- Date-- -------------- ------------11,------- ------ --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVIrIED 9-59 3M 3-'63 F.P.120.