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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...�._ ..... ------------------ ---------------------------------- ------------------------------------------ ------------- (Complete in Duplicate) _..___________________ 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. This application is made in compliance with County Ordinance No. 549. !J JOB ADDRESS AND LOCAT O ... -------------C ---------L----------------- ------------•------------- tt Phone-------------------_------------- C 4 -----`� c Owner's Name-------------------------------- - -------- 'A -------•------------ - ------------- a , Address----------------------------- =- 3----- ...--------�-- "� Contractor's Name -----------------�--.� ;.._.. - - -- ------------- - Phone..._..-----------------•---•------- Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel [3Other ❑ Number of living units: .___ __ umber of bedrooms ___ Number of baths,__/-- Lot size ____-7_- ._�_.��.�______----------------------- Water Supply: Public;system ommunity system ❑ Private ❑ Depth to Water Table --,4l ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe OR"'Aardpan 0 Previous Application Made: (If yes,date____________________) No New Construction: Yes lo/❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T : Distance from nearest well ____`"_� _Distance from f6un4ati6n-_-.1-D __.______. p .----------- Liquid depth__.`; �"�.1. _..Capacity -. No. of compartments--- Size_____, __ Disposal eld: Distance from nearest well.. ,_.Mstance from founclation___l_c�___`_.... Dis#ante to nearest lot line., Number of lines- -- _ Length of each line------/ ; �f -__ � Width of trench.--- Type of filter material__ r--c•-c--_V -__._;--Depth of filter material 8---•______._._Total length-----lj$7a__________________________ i Seepage i Distance to nearest well------ Distance from foundation___�_Q_...____.Distance to nearest lot line__.,._._____ Number-of pits- _ _ -----_--___Lining matenal_:� �_ �_�___.Size: � -------Depth------0._� �' 'a Cesspool: Distance from nearest well_________________Distance from foundation--------------.__�.Lining material--- ❑ Size: Diameter--------------------------------------Depth------------------------------------------------;.:Liquid Capacity.---------------------------gals. Privy: Distance from nearest well------_--------------------------------------- _Distance from newest building.----------------------------------------- 171 Distance to nearest lotline-----------------------------------------------------------=------------=--=--------------------------------------- ------------------------- Remodeling and/or repairing (describe 1 J -- -- - -------- ------ ---•----------------------- ------- --------------------------------------------------------=----------------------------------------------------------------------------------------------------•---------------------- ••---------.-•------------------------ I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed} -----p----- ------- ----- ----------- r---------------------------------------------------------------------- (Owner and/or Contractorl By------------------- -- - ----- ------- ---'-- � ---------------------------------------------(Title)--- --f------- --- - -- -------------- -' n, --------- (Plot plan, showi ze of to locatio ;,of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ � -'G'z '------------- -------- ------ DATE-----C -----------=------------ REVIEWEDBY------------'-------------------------------•--------------------------------------•--------------------------------------- DATE------------ BUILDINGPERMIT ISSUED-------------------------=----'------------------------------------------------------------------------ DATE.--------------•------ ----------------------------•-------- Alterations and/or recommendations-__1 ------1yi -k-€ -K----r'__f_►.t-------a Z V_+tt-------•-•-- ............ �5.--•---•------- ------------------- -------------------------------•-•---•_.---------- ------ -------------- -------------------------------------------------------------------------------------------- ---------- ---------- --------------------------- --------- -------------------------------------------------------•--------------------------- --------------- -------------- -----------------1_------------------------------------------------------------------------------------ ------------------------- --------- ----------------------------------- FINAL INSPECTION BY: =--C-- -..----- r Date--- r'F—_d�� --. --- -------------------------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California l REVISED B-59 F.P.CO.2M 6-60