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FOR O,FFICFnU$1 : I 3------ -- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....__-------- ........ ------ -------- ---------- ----------------------------- .. (Complete,in Duplicate), u ( 3 . .�,_.. ----------------------------------- This Permit Expires 1 Year`From Date Issued Date Issued .___._ ._ �`______ .. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, i This application is made in compliance with County Ordi ante o�549 �+ f3 4 JOB ADDRESS AND LOCATI N_Xo '".-_.._- ------- ----------- Owner's, " �t Owner's Name--- --------- •. -- ...... - A - Phone----------------------------------- Addressi . .. !' - ---------------•-------------------........-----••--------------__-----------------•-•- Contractor's Narrle'.-- '•-------------------------------------------- -- -- --- -- - ----- ---------------------------- ----------- Phone-.--.------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ;__ ___ Number of bedrooms Number.of baths /-Jot size __`�P_Q____ -___._--_____`� �.�,__..,_. ��_; —. `_'........a, .x# V Water Supply: Public system ❑ 'Community system ❑ Private, Depth to Water Table 7---.a_ ft. VCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' Clay ❑ Adobe•❑ Hardpan } Previous Application Made: (If yesdate____._.__-,.._.._--) No ❑ New Construction: Yes ❑`No� FHA/VA: Yes ❑ No EE11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w a ep c ank: Distance from nearest well--------s._w.__Distance from foundation___________________Material_____________.._________,'______.__..__f____ No. of compartments-------------- `-=A---Size-------------------- ----------Liquid depth------------ ------------Capacity..---------------t `bis os Iteld- Distance from nearest well'" _____._Distance from foundation-S,�__--__--.Distance to nearest lot lineNumber of lines_______ ______ ;_-- - -____-- t Length of each ;line___ _�__�._--------Width of french---- _ ._ _�_.__ Type of filter.material__ _E__ _ _�1C: Depth of filter material__, _____._.__Total length______________________ __�--------- I � , A 41 e ' > 5eepa e Pit: Distance to nearest wellQt�__._._.___Distan om f'"undation_._., ��_____.Dsst nce to neares# lot line__ .' Number of pits_.._/______________Lining materia _..Size: Diameter-__ - .Depth__.. ,_X__e-_ -- *" tt esspool: Distance from nearest;well______ ---Distance,from.-foundation...-----------------Lining material__._____.______.__________________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gal y Privy: Distance from nearest.well------ ----- --------------------------Distance from nearest building------ --------------------------'----=-. I ❑ Distance to nearest lot line ------. ----------------------------------------------------------------------------- 1 Remodeling and/or repairing (clescribe):_----- ---------- - -------------•-------•°-•---------------•---••---- ---------------------------------------------------------------'� F ) ----16-- ----- ----------------------------=--=--------°-- ---- --_- -:-_-- --------•- ---------------------------------------------=---------------------------------------------------------------------------------------------- --------------- - - --------- .o- - I hereby c I h that I have prep d this application and that the work will 'be done .in acco dance. with San Joaquin County I- ordinances,.$ 'el 's;end ru ks and re Llations.of the San Joaquin Local Health District: 0� (Signed)-------- -- ----- - ---------- ------- - ner and/or Contractor) r r --- _ w + -- !By:..�--•-----------' - •....................... ............. {Title)--- - ------ (Plot plan,-showing size of lot, location'`of,system in relation.to.wells, buildi : s, etc., can be placed on reverse side).' FOR DEPARTMENT USE ONLY } i APPLICATION ACCEPTED 8Y- .. ..-*- -yam ------------ DATE----- _ > ,+a---------------------- -- - - -- ------------------------------------------------------------ REVIEWEDBY------------------------------------------------------------------------------------------------- -------------------------- DATE------------------------------------------------------------- BUILDING ----- ----------------BUILDING PERMIT ISSUED------------------------------"---------------- -------------------------------------------------• DATE---------------------------------- r. 3 - ,v. .. •----------- 1 1 Alterations and/or recommendations_____________._________------_---- _ - - -- i ' �4 4 1- # �-., f - ' --------------------------------- -- - ----------- ------------------ ------------------------------------ --- ------- ' = �. ---------------- --------------------- ------------------------------------ ---------------------------------••------------------------------------------- ------------------------- ---------------------•--------------- FIN M � ... �,_, _._.,-�...a _ . AL INSPECTION BY:-------- 't _..__� _ -- ___________ Date._._ ✓_. .._____ t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1 Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 6-59 3M 3•'63 F.F.r.D. 1