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FOR OFFICE USE: z01_ _.�_~_y1�_7______ jl APPLICATION FOR SANITATION PERMIT Permit No_ __ ______ --------------• ----------------- ---------------------- di, (Complete in Duplicate) zJ 6 i.. Date'Issued ---- ---------------- f 3 = _______________ _ --: (This Permit Ex :res 1 Year From Date Issued ----------------- I',, 4 Application is hereby made to the'San Joaquin Local Health District for a permit to construct and install.the work herein descried. Thisap lication is made.in compliance..with County Ordinance No. 549. j�}-��♦� Q5—/lam I . F Fi i . JOB ADDRESS AND LOCATI N .�.__� �- p = _ 'r - - Owner's Name__ c � r f a '� ----- = -----•------------ ' - --- - -- -- --- --- ----- Phone -------•------------ Address---------- --------------------------------- -S I' Con#'actor's-Narne-= =T'� ----• --------• -------------------------------- ------- Phone----------------------------------- ------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ._Number of baths ___L___ Lot size ------------------__-______ Water Supply: Public system ❑ !;Community system [I Private E�--Depth to Water Table ,0 ft. Character of soil to a depth of Y feet: Sand E] Gravel ❑ Sa y Loam El Clay Loam ❑ Clay �obe ❑ Hardpan C2Previous Application Made: (If es,date--------------------) tNo [ New Construction: Yes ❑ No �FiA/VA: Yes E] No TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted-if public sewer is available-within 200 feet.) i „ r Septic T nk: Distance from nearest well 40________Distance from foundation___ZQ---------_ tenial___-��----- __--1`�. �No. of compartments__ �- -_4 --------------- Size..___ r '_ _:__Liquid depth--�------------------Capacity----- Dispos 1 Istance from nearest wel�_______-_.Distance from foundation_,A_r____ef:_Distance to nearest lot line--4' ----------- Number of line:i6s_____ ______________________Length of each line-------20-____-___:-:Width of trench_________�,_ __.y.____--.___- (qK�t of filter materials-.' ._-_____Depth of filter material__� ___.___t__Total length------------------------------------------ Type See ap ge Pit: Distance to nearest;well_�1>Q________"-_Distance from foundation__,(__-J'_'Distance to nearest lot line_S ,_______� .� Number of pi#s.._--- -_� -- --------Lining rmateria�¢_4c/�__--.Size: Diameter-- -;._�-------------Depth__ j_____.---------------- � r t _ ,� Cesspool: Distance from.nearest well------- -___!__Distance from foundation > -Lining material-------------------------------------- ❑ Size: Diameter,------ - - -------------------Depth--- '___1_ �'•--•. Liquid Capacity gals. Privy: Distance from'i'nea est well___-----_-_r7-:'_____________________________t---Distance from nearest building------------------------______ j, ❑ Distance to nearest lot line---------�------ --------------- --------------------------i----------------------------•---------------------------------------- � Remodeling and/or repairing (describe):---------------__._ _-------_---------------------------- ___________________________-----------------------------------------------------------------------------__________________________________________________E_____-__-___-________________-_____.________________-_________--_---- _------__-_____________________________________-.--____-__I_______'______________________-__________________.._....--.._____ _____________-_--_-----------____________--._____________-.. --______ ___-________-___-_-_ -----------------_------ _-----------------------------------;------ _;_-_____-____.__•_______,,,___µ_______________--,__---__-_______________-________-_____________-____-____..__-__-______--__----_-_.- I hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg latio of the San Joaquin Local Health District- a (Signed) -----'--- ----- --------- ------------- By: ---------- (Owner and/or Contractor) 9 )-----------•---- ----- Plot Ian, showing size o of, locate title 6 •--•----•------ ----- ------=---•------------------------------------- ------------------ - ( p g �„ tion of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY____-:,- __ ___ ''L� __________________ -----------------------2 DATE----' ----------r ----------------- 'I REVIEWED BY---- ------------------------------------------------------- -------------------- ---------------------------------------------- DATE--------------------------------- Alterations and/or recommendations: DATE____________________________________________________________' ns•------- ------•--------------------------------------------- BUILDING PERMIT ISSUED_...ata � -��r:__:�"� -----z :��` � � "��. � `a�'L" ` � ------------- - � ---- •----------------------------------------- -------------------------..._._--------------- — — ------------ ------- ------------------ -- •----- -. v a --------------------- -----------------------------------r---------------------- --------------------------•-------------------------------------------------------•----------------------------------------•_'_-._._-.---- - '--------------------------- ---- --------------------Y-------------------•------------------------------------------------ ------------------ ------------------------------•----------------•---------• ----------- ji FINAL INSPECTION BY:......�----- - ----c��--- ------ Date_- J/� -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifa:elton Ave- J 300 West Oak Street 124 Sycamore Street 205 West 9th Street I: Stockton,California I Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.PMD. ii