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FOR OFFICE USE: ----------- - ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... . .---- ----------------------------- --------- --------------- (Complete in Duplicate) �- Date 'Issued ___ --------------------------------------------------------- This Permit Expires 1_Year From Date Issued 1 Application is hereby made to the San.Joaquin Local Healfh District for a permit to construct and instalthe work herein described. This application is made in compliance with County Ordinance No. 549. k f{--�tj t Z3 LI - ` k ----------- ------- 8)DJOB ADDRESS AND LOCATION: I '------------------ --------------------------._. •- _--- ------------a---- Owner's Name__ � Phone Address-.-------- -3-., - Contractor's Name---- -- • ---------------- •---••------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ oIt ❑ Trailer Court E] Motel ❑ Other F]f � ' ! Number of living units: ---�_._ Number of bedrooms ___ -_ Number of baths a.-?-,.,[of size ----d-__ _--_ -+_________________________________ Water Supply: Public.system ❑ Community system ❑ Private 0( Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [X New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , - (No septic tank or cesspool permi#ed-if_public.sewer is available within-200 feet.)-- Septic Tank: Distance from nearest welL__._�. __ P Distance from foundat�on____.�-______._.,Mat No. of compartments--..-)�__________ ___Size /'-- --�(--_Liquid depth____._. ___Capacity_,, P /� �___ ' Disposal Field: Distance from nearest well ) Distance from foundation____ _'_"-1 __.Distance fo mearest lot line__._I�______-. Number of lines------ Length of each Ii/,p CJa 1 9 l id o' rencr--------------•-- Type of filter material___`1��(__Depth of filter material---- �--- --__Total length____- _. - r___________ --------- Seepage Pit: Distance to nearest well------.---------------Distance from foundation__________________Distance to nearest lot line--------------___ ,+ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- 7 Cesspool: Distance from nearest well----------------_Distance from foundation------------------- material----------------------------.--------- ❑ Size: Diameter-------------------------- ----------De th------•------------------ -- --0 Liquid Capacity Distance-from nearesi buildln 'Privy: Distance from nearest well"-a---- -------- g------ --------- ❑ Distance to nearest lot line______________ - -------------------------------------- ara,ew Remodeling and/or repairing(describe) _=--------•------•-------••--------------•--•---------------- ------------------------------------------------------- ' K l-M- yr -- -------------------- ------------------------------------_ ___ _______________________________________________________________-:-_~-_-_+„T___________________-_____________________________________________.___.____-____________--_.-_______-----__ I hereby certify that I have prepared this applicatio and that fhe:work will be done in accordance with San Joaquin County ordinances, Stat, law; nd rules and.reg ,atio_ns.of the: an Joaquin Local Health District. } f [Signe _--_____K_ _ -•_ ��_ {(Owner and/or Contractor) ----- ------- --- ---- . � -f wn o or r gY� --=------------ --------------------------------------------------------------------------------------------------------------(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--------------------=----- --------------------------------- REVIEWEDBY---------------------------------------------1----------- ------. ----- -- DATE. ... - - `- f BUILDING PERMIT ISSUED-------------------------- *----------- -- _ DATE--- - --- 4 Alterations and/or recommendations:__--___L- ____ tz-� / r.._-------------------- --•--------•------------------------------•-----------•--------------- --------------------------------------:------------------------------•---------•----------------•--------------•------------•------------------- -------------------------------------------------------------------------------•---•--------------------------•-------------------------------------------------------- ---------------------------------------------------------------------------- ---------------------------------- ------------- FINAL INSPECTION BY-------------- Date------ SAN JOAQUIN LOCAL. HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ice, Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.M.