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/ F9&OFFICE USE: �y ----------------14-``�`� r Permit-No. ._ ----_---_-- - --------------- APPLICATION- FOR SANITATION PERMIT 1 ------------------- -- ------------------------- -------------------------- --- - - (Complete in Duplicate) 1,2 __.__: This Permit Expires 1 Year From Date Issued Date Issued _______ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 544. JOB ADDRESS AND LOCATION __ �.� _ , ---- - ---- ------------------••----- = Owner's Name - •...�------ ----------C t Phone.:.... Address_"- - Contractor's Name-- ----------------- } ------ Phone----------------------------------- ,� Installation will serve: Residence A artment House Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units:::__ ____ Number of bedrooms ___ Number of baths._'____ Lot size ------/3?-*-"A)"= ---------- ------------------ Water Supply: Public systemY Community system ❑ Private ❑ Depth to Water Table l4_4 ft. Character of soil to a depth of 3 feet: ` Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe&-�Hardpan ❑ \ Previous Application Made: llf yes,date_----_._...,__.__--) No New Construction: Yes [�o El FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distan from fou dation_1C-F�_.._-__.__._.M teriall- xf x -,_--Liquid depth__ ------------------Cape ity__.: 1 -. No}of compartments--- ---------"""---Size__- + Disposal field: Distance from nearest well._..__`-_._____Distance from foundation___"..Q________-_.Distance to nearest lot line_________________ vL _ 9 - �f 11 Number of lines_____ __ -Length of each line___7Z__.____<<_._______.Width of trench-_-4w_. -_______:___.___--- Type of filter material_: ________Depth of filter material- _t length____ Jz'__ ..________ E "r:--�-- Seepage Pit: Distance to nearest well---_-- -----------Distance irgm foundation---fp-----------Distance to nearest lot line- ----- Number of pits---- "_______Linng material___I__ rbS_C_.Size: Diameter 95 Depth --------- Cesspool: Distance from nearest well-----------------Distance from foundation-----_-------_------Lining material-___._______--:_-_______.____._____. ❑ Size: Diameter-----_------------------------------Depth-----------------_------------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_________-----------_---------_-----------------Distance from nearest building__._______-_._____________._-_f___.______. ❑ Distance to nearest lot line --""" ' -------------- ----------------------•----------------------------------------------------------------------- Remodeling and/or repairing (describe :..........................=-------------------------------------------------------------------- ------ ---•-------------------------= --------------------------------------------------------------------------------------------------------------------------------------------------- ► --------------------------------------------------------- --------"------------•--------------------- --- ---------------------- ----- -- -----------------------------------------------------------------------------------------------------------------------------:----------------------------- --------------:--------------------------- I hereby certify that I have prepared is ap ication and that the work will be done'in accordance with San Joaquin County ordinances, State laws, and rules and re atio of the San Joaquin Local Health District. { , -------------------------------------------------•--(Owner and/or Contractor) By:----------:-----------------------------------•---------�•- --------------------------------------------------------------(Title)--------------- --------------- -------------- - -----"---------- (Plat plan, showing size of lot, location of syste in relation to wells, buildings, a+c., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----� ---- --------------------- DATE--- -z"'' ---- - -------- REVIEWEDBY-- #--------------------------- - ----------=------------------- ----,------ ----- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--:------------- ---- i-----------------------------------s-------------------------------------- DATE-----------.._..---------------- " --"- 7 - I- -- --� ii-S e,±, -�----`---�`�-� `�- s Alterations and/or recommends+ions::_. _ -'.".__ _'.."t4'-�------ `` -----•-- L ----r-Z''--'ter--- --------------- ------------ -- -- -- .-�-�---.!_�1.�`k?i.�.,x.�-4---"---------�----=-�-`--��'- ------ ---- -- --------------------------------------------"----------------------- --------------------------•--------------------- ---------------------------------------------------------------- ----------------------------------------------------------- -------------------------•---------------------- FINAL INSPECTION BY:.- C•-'"" �5 Date ..... �' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. - rte