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FOR OFFICE USE: ------------------- -------------------- ---------a___._-------------------------------------- APPLICATION FO`kiSANITATION PERMIT Permit No, _A_.a'eL : - --- ------------------------7m----------- ------------ (Complete in Duplicate) i ----- --- This Permit Expires 1 Year From Date Issued Date Issued raL f Application 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. JOB ADDRESS AND LO ATION______. ...:� _ �- `' , ,--1t1 = = F ---------- Owner's Name--------- -- ---e- --- ------ ---- •-• -- •- --------- ------------ ---------- -- -="-- ------ Phone-:---------------------d -------- Addressy ' /7 Z----------------------- ------------------------------------------------------------------- Contractor's Name---- 1---__..-•-z -- ---- -------------------------------------------------------------- --------------------------------------- Phone-----•-•------__________-=••----••- Installation:will serve: JResidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin units: _ ___ Number of bedrooms .__ 9 umber of baths ___ Lot sae _____.____._ Water Supply: Public!system ❑ Community system ❑ Private ❑ Depth to Water Table ______ ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_..........I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE=0F INSTALLATION AND SPECIFICATIONS: ..-_. (No septic fank'or cesspool permitted if public siewer is available within 200 feet.) Septic Tank: Distance from nearest well;2�61-_____Distance .fro four•dilation------A?----:_.Matgria)______._________________________________________ .` No. of compartments__--- -______-- Size..--_-.,. - --,l _�1.:_--Liquid de th-------- -----Z—_'Capacity----g'�_Q------ Dis osal Field: Distance from nearest well., -5"6----- { P DistancAb �acq orrtjounclafi :. Distance to nearest,lot" line----:)________. Number of Eines____; Length fine_ `_3_c5 `4S'Width of trench Type of filter material_-__ Depth of filter material_j--- length-------l_��------ ----------- 0 Seepage Pit: Distance to nearest well----------------------Distance from foundation----.---------------Distance to nearest lot line-------- --------- ❑ Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth-------------------•------------- G Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-__-_____--_________ _-- ❑ _ ' Size: Diameter-------------------------- -- _Depth -•--- ------ - -------Liquiid Capacity ---------------------------------gals. ----- - - ---------- ---. -- Privy: Distance from'nearest well--------------------------------------------------Distance from- nearest building----------------------------- ........ ❑ Distance to nearest lot line- •------•--------------- ------ -------------- --------------------- Remodeling and/or repairing fdescribe):------ ---------------------------------------------•---•--------------------------'--------- -------- #------------- = ------------------------------------------------------------------------------- ------ ------------------------------------------------- --------------------- ---------------=-------•----•-•-----•-----------------------------------•----------------------•-------------------•--------------•-------------------------------•--------- ------------------------- ordinancesbSt---.------- ------------------------------------------------------------------------ --------------------------------------------------------- ----------------------- --------------- -=------ certify that! have prepared this application and that the work will be done in accordance with San Joaquin County State laws, and rules and regulations of the San_Joaquin Local Health District. (Signed)_ - a Contractor) --- ---= ---------------- _ caner and/or Cant a tar) $Y D ------•-- ------... ---- -- -- {Title) ----- ----- (Plot plan, showin size of lot, location of sffein relation to wells, buildings, etc., can be placed on reverse side).- FOR rDEPARTMENT ide).-FOR.DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY----------------- ----- ------------------------------ ---------------------------------------- DATE--------------------- REVIEWED BY- ------------------------------------------- ---- ------------------------------------------------ ---- ------ DATE - -- - BUILDING PERMIT ISSUED----_•:---------------------------------------- DATE------1---� ��_ Alterations and/or recommendations:. •----------------------------------- -- ----------------------------------------------------- ---------------..-------_---------- ---------------------------------------------------------------------------------------------------- ---------------------------••--------------- ---------------------------------- ••------------------ ------•--- ---------- -•-------- - ,, --------- a--` --�-- ------------:--:_-------------------- ------------------------ - ----------- - ---- ----- ----------- r FINAL INSPECTION BY---------------- - ---- ------------------- ----•---------------- Date-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street /r 205 West 91h Street Stockton,California Lodi,California , Manteca,California Tracy,California CS 9 REV155D 5-59 3M 3••63 F.P.CO.