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FOR OFFICE USE: -- ------------------------------ -----.-------------------- APPLICATION FOR SANITATION PERMIT Permit No. __a ______....__._-. ------ -- - ----------------------------- ------ (Complete in Duplicate) _ Date Issued ____,__, ---------------------------------------------------- ^ FThis Permit Expires 1 Year From Date Issued t Application is hereby made to the San Joaquin Local Health District for a per to construct and inst ll.th work herein described. This application is made in compliance with County Ordinance No. 549. �/, t,�;PD j• ZI r--! � �t JOl3 `A DRESS AND L CATION = � = 1 1� '��f -- A—---`-----'�`-`-- ---- - Owner's Name-------------\- v: ---- h !J2 � 7------ Phone Address-----------------------=- .._._ �'..��-! -lam-----• -=-------------- Contractor's Name---------_-••--------_-•-------------- �� !'� �--------------------- --------------- -------•-- --------------------------------_ Phone--------••----=---------••-------•- Installation will serve: Residence A artment House } X p ❑ Commercial ❑ Trailer Court L] Motel ❑ Other ❑ Number of living units: _-1_____ Number of.bedrooms __ice_._ Number of baths ---f__. Lot size _ OLi__X_.j6_cD_______________________________ Water Supply: Public system ❑ I Comrflunity system ❑ Privat Depth to Water Table /0 ft. Character of soil to a depth of 3 feet: Sand N[J.• Gravel ❑ Sandy Loam El Clay Loam ❑ Clay;K Adobe [3 Hardpan ❑ .. Previous Application Made: (If yes,date--------------------) No�d New Constru do �s E] No [[� FHA/VA: Yes ❑ Nok TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic'Tan Distance from nearest.well-----------------Distance from foundation--------------------Material----_------------------------------------__--_-- 2 No. of com artments=___ _ __________ ___ _ Size_.____._.________. �/� P Liquid depth Capacity (�ispo al Field: Distance from nearest-well---- -`a---_-Distance from foundation______/__Distance to nearest lot line____ �f`-_____-_ Number of lines----------- t4 ___._..___ ___Length of each line--------CZO ___ f�_-_.Width of trench-__�,_r�- _� Type of filter material__v>-�-��'1" ___Depth of filter material-------J_�___-____Total length---------�0_____________._-________ e age Pit: Distance to nearest well_____ ---------------Distance from foundation--------------------Distance to nearest lot line__-.______.____.. O ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------------------Depth-------•-------------------__---- C Cesspool: Distance from nearest well_________________Distance from foundation__-----------------Lining material__---_._______.___________._________. ❑ Size: Diameter-------------------------------------Depth----------------- ---------------------------Liquid Capacity-_ --------gals. e...:._,--.. .- —.. :T-Y rte-`` �- w-.YweY-�.. r—'�"'-. Distance from nearest well:_________`_____ _ _ _ .Distance fram nearest building Distance to nearest lot line------------- ------------------------ ----------------------------------------------------------------- r ' g P g (doscribe): — �—�- --------------- -------------------- X ` Remodelin and or re airin d scribe :_-___ _--[Cs-� r - ------------------------------------------------------------------ -------------------------- ------ - - --------------------------------- ---------- -----------•------=----------------- ------ ----------------------------- ------------------------------------------------------•---------------.--•----------------•-•------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State l9ws, and rules and regulations of the San Joaquin Local Health District. , L - (Signed / - ------------ -------- --- ----------------_(O--w--n--er and/or Contractor) 1 BY: l---------•--•----•------------------------------------------------- - - -(Title ----------------------- ------- • ( ) { (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,,can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------------------------------------------- ------ DATE---------------------------- REVIEWED PERMIT ISSUED--------------------------- - fit �TE --� '`��•� - REVIEWED BY------ ------------------------- --------------------------------------------- ------- ------------------/ DATE--------------- - ---------- Alterations and/or recommendations.-- �--------------------------•---------------------------•---------------------------- ------------------------------------ -------------------•--•------------- ------------ --------------------- ------------------- ------------------------------- ---------------------•----- --------------------------•------- ----------•--------------- ------------- -------------------------------------------M----- -- --- ------ ---------- ----------- FINAL --•------ -FINAL INSPECTION BY:...... . ------- -------------------------------------------- - Date---------r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.liaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California EB 9 REVISED B-59 31A 3-'63 F.RCD.