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FOR OFFICE USE: ------------- - -- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ - ------------------------------------------ (Complete in Duplicate) 7 / Date Issued .._..__..�.�_ ! .__.._______._____.________________________________ _ _ This Permit Expires 1 Year From Date Issued i 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 Coun Ordinance No. 549. p JOB ADDRESS AND LOCATION-_ ---- Owner's Name._C -------- _--•-•- - Phone-_-------------------- ---------- -------- Address-------•-----Z " ---------------------------------•--•--•---------------------- ------ ` `` `� � Contractor's Name_-,(�: -- #9f__ -- -•-- �-T Fes- , ". • - R----------_ Phone.4(P�±. �'Y-. � i _ _ _ _�__�_ _ � ,•�. �...�r .�R I 1 - _ Installation.w..ill.serve: Residence. partmentVHouse ❑ -.Commercial —Trailer-Court ❑ Motel:-[D, Other,[D Number of living units: I_____ Number of bedroomsJ---- Number of baths _/f___ Lot size p � . 1 Water Supply: .Public system ❑ Community system ❑ Private Depth to Water Table ea ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Ha!dpan P ❑ ❑ Y ❑ Y ❑ Y ❑ 16j Previous Application Made: (If yes,dote--------- ..........) No E] New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: I � (No septic tank or cesspool permitted if public sewer is available within 200 feet.). � ) rt m.. �. ell i�,,�Tank: Distance from nearest weld__ _.__ Distance fro foundation___��__.____.Material_ - _ _____ __ ____------------------- Septic /�'[^�I , .. No. of compartments--- R--------""---- --5ize � - �.---Liquid dep',th-- - .---..-. ,Capacity--- Disposal:Field: Distance from nearest w1ell._,2_0-`--_._Distance from foundation___,(_. __ istance to nearest lot line__-��__ .. `t*'�tNumber of lines_____ __ __. __Length of each lin !-I—!� _.��- . idth of trench-[�.L�-�--_r---_-'-�_--__ �� \ f ,. T e of filter materia Depth of filter material____- Total len th__________________e �_ __________- p g e a e Pit: Distance to nearest well- Y p g p _ �:D.istance;;�jjrom fo ndation,P� __�-Distance to nearest lot lin --- Se Number of its____ in`material__ifS,� S�* ..Size: Diameter__�_��_..___..Depth-_u x-of______-_____.___- Cesspool: Distance from nearest weil___..._____._Distance from foundation..-.-'--------------- Lining -------------------------------------- 171 Size: Diameter------- --------- ---- ---- -------`--Depth-------------- --------------------------....Liquid Capacity i i als. Privy: Distance from nearest welled-_________ -------------------------- _______Distance from nearest building--.-_---__._____-____________..----- .-, ❑ , Distance to nearest lot line.____.__________-______________________ r` --'II .� . . a �, !� RemodelI g,and/or rep .Ir ( scrilae�:--T - --------------- f ----------------- -----------------------•------------------------------- IV _________________r_------------------_.___------------________________________.______._ _ _________r/_^/_f_._-_.___.__. _____a ------------------------------------------------------------:___4__...___ _..___._._____=_a______________________________________________i______------------ _ _ _ _ _. _A.�r_T__________________._______-_______________.__________________ ___._____..._ '• ------------_-----------_-----------_------------------------------------------------------_____________________________________________________________________________________________________________________------------ I-"hereby _ _________!"hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquinf County „M,,,,,,,,,;ordinances,`S to laws,"and rules and'regulations of the San Joaquin Local ealth District. (Signed) 1' - C--Ll- -�I�`I-ict, A. rr +-------------------------------- 7adfor Contractor) , BY: . -------- (Title) , (Plot plan, showing size of lot, location of system i0elation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY-- . . -----~ ------- ------- ---------------------------------------- DATE------* _7Z -----V-------------- ----------------- REVIEWEDBY------------------------------------------------------- ---------------------- --------------------------- --------------_- DATE----------------- ------------------------------- ---------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------------• DA•TE----------------------------- ------------------------------ Alterationsand/or recommendations------------ --- ------------ ---------------------------•-------------------"---"-----•-----•-•-----•-----------------------•----•------------------------- ----------------------------------------------------- ---------------------------------------------------------------°---------------------------------------------------------------------•-----•--.------------------------------------"--•----"_.--.----------------•------------ ------------•-•----•----------•----------------------"---------------------•--------------------------•------------------------------------------------------------------------------- ------------------------------------- -----.�-�+ ---: t FINAL INSPECTION BY:.. ---------------- Date r- ---- - - ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Matellon Ave. 300 West Oak Street C11124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Monteca,California � Tracy,California RS 9 REVISED B-59 3M 3-'63 F.P.CD.