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FOR OFFICE USE: ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. l_--------------- ------------ ------------------------------------------- -_----- .___------------ ------------------------------------------- This Permit Expires 1 YearFromDuplicate) Issued bate Issued Application is hereby made to the San jJoaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance with County Ordinance No. 549. 17 _ u JOB ADDRESS A D LOCATION'_ ________ ___----_ ____ __ + ------ Phone - Owner's Name �..... +_ -- --- ------- -.-.----- /�y -------------------------------- - 00. Address -------- '! ._ _ � --------------------- -------------------------------------------------------- --------------. Contractor's Name--•------- - ' - -------e4----- ---------------------------------------=------------------- Phone--------------=-------------------- Installation will serve: Residence [PI/ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___,. Number of bedrooms _ f 4` . Number f baths __�___. Lot size __.��1-___�_..��-�_________________________ qk Water Supply: Public system ❑ ',Community system ❑ Private Depth to Water Table -------- ft. j Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------) No ❑ New Construction: Yes .❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) Septic Tank: Distance fronearest well_________________Distance from foundation-------------------Material------------------------------------------------ v No. of m compartments Size `Liquid-. epth---------- ---- ---------Capacity------------------- 5� Disposal Field: Distance from nearest well-________________Distance from foundation--------------------Distance to nearest lot.1ine----------------- �..:,_ El Number of lines-----------------------------------Length of each line----------------.-------------Width of trench----------------------------------- Nh Type of filter material______.__________________Depth of filter material____________________ _Total length_-__-_--_._.__-__:_______________________- . Dp� . .�t i C See age Pit: Distance to pnearest well______ g � Size: Diameter i/� _..Distan veto nearest lot line----,.S_______. p .�__ __Distance from foundation______ r Number of its--------[------------Linin material----- _- _ _ __3-3--------.Depth..... 'r---------------- j. Ir Cesspool: Distance from nearest well------- ------Distance from foundation--------------____"lining material__._____---____________________-_. ❑ Size: Diameter,-------------------------------------Depth--------------,------------------------------- Liquid Capacity------------------ ---- -gals. . , 1 Privy: Distance from `nearest well--------------------------------------------------Distance fro -nearest building----------------.__.__.------------------ ❑ Distance to nearest lot line----------------------------------------------------------------------- � Remodeling and/or repairing (describe):-----------6 ^ ` I _______________________ n ri ----------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be`done in accordancer with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t (Signed) -- ----- - ------------------ - r and/or Contractor) By---- ----- ----- - ------------------------------------------- [Title] ` ---------------------------- ---------------- By plan, showing size of lot,.location of syste in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- i REVIEWEDBY----------------------------------!----------- -------------------------------------------------------------------------- ---- DATE"-------------------------------------------------- BUILDING -------------- -- - - BUILDINGPERMIT ISSUED---------- 1�---------------------------------------------------------------------------------- -._ DATE-------------------------- - - , Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------- ---------•- ------------------------------------- ,I --------------------------------------••-----•--------------••----------------------------------------------------------------=----•-----=-------------------------- ---------------------•-----------`------------------- -------------------- --------------------------•- •----- ------------------------------- T---•------------------------------- ------------------------------------•-------------•------------------------ _______________ ___________________"._.___"__.-.___________________.___.-4._.-._-_-_"-.___._._--r_ __-_-____-___!____._.__-________-_-.______-_._-______.------------------------ __-_______________.-.-_____ FINAL INSPECTION BY:_ ..-.---_-_-- -- -- _._- .t� ---- t �� Dat,--- Cst-` -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 n1=VIS£D 8-59 31A 3-'63 F.P.CO. 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