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FOR OFFICE USE: ------ ------------ -" --------------------- ----------------.___--__.____-____. APPLICATION FOR SANITATION PERMIT Permit No. .. .:_ ------------------------- ----------- ------------- (Complete in Duplicate) i Date Issued ___ - s--- ----- ----- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cons rut and install the work herei escrib This application is made in compliance with County Ordinance No. 549. 9-1, t J: n L, 1-70 u LCATI ----------•- ----------------- -- JOB ADDRESS A Xi�OAK_4_0' � — ----- Owner's --------------- Address------- - --: O --- ------------------ _ ? ' (p9�Contractor's 'Name------- --- -. ._ Phone---�------ �/ ..... Installation will serve: Residence Apartment House ❑ p ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other Number of,li�ing,units: ---�__ Number of bedrooms -I___ Number of,baths -__ Lot.size __-, "U4 - -------•-•-------------------- i Water Supply: Public system ❑ Community system ❑ Private _ Depth to Water Table/,__ ft. Character of soil to a'depth of 3 fee+: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made- (If yes,date._---`-..."..__..__.) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) a"k: Distance from nearest well-"______________Distance from foundation--------------------Material 0 __.________:.___--__ ._ I No. of compartments5ize------------------------------Liquid depth-------------- -----------Capacity--------- O Distance from neare*TW:. well _____._Distance from foundation._,�Q ________Distance to nearest lot Gne. _, Number of lines______ Len th of each line_ '� ' - g d-- - �VO��d�th of trench.Type of filter material_ A --Depth of filter material ,l_ "----- To a'�Jeng T 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 well--------------___Distance from foundation._._ ___.Lining material...___"..____"__________-"____ --- f0 ❑ Size: Diameter-------- ----------------------------Depth-------------------------------------------- -------Liquid Capacity-:------------------•---. gals. � Privy: Distance from nearest well----------------- Distance from nearest buildin -------------------------- ❑ Distance to nearest lot line.,______ __._ , /� � ��-�-------------••---------------------------------"---- Remodeling and/or repairing (describe):_ � ---------------------------------------------------------------------------------- ----------------------•-•------------------------------------ ---------------------- -----------------------------••--------------"----•-----------•---------------------------------------------------------------------------------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y� #ordinances StNfF a , and rules and regulations of the San Joaquin Local Health District., r.. z (Signe - - - _ , ne d E t B � r and/or Contractor) 0re ' Y� -------- --- ---------- (Ti ft rale}------- - ---�---------------- _Z --•--- `(Plot plan, showing size of lot,..loca+ion of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ------- ------------------ DATE------- ' - - - - - ------------------------- -- REVIEWEDBY--------------------------------------------- ------------------- -- - DATE----------` - ------------------------------------------------- - ---------------------- BUILDING PERMIT ISSUED- --------- ----- ................. DATE------------ 'Alterations and/or recommendations:--------------- -------------------------------------------------------------__________..___ - -------•----------••-------------------------------------------------- 4 -•------------------------------------------------x----------------------------------- ----------------------- -----------------••--------------------------------------------- ------------------------------------------- I FINAL INSPECTION BY:. -- Date------ a--- --- j " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 16 ,� 205 West 9th Street d _ _ Stockton,California Lodi,California F _ ..#- Manteca,California : Tracy,California ES 4 REVISED 9-59 3M 3-•63 F.P.CO. �"•`r