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FOR OFFICE USE: qlc- � APPLICATION FOR SANITATION PERMIT Permit No. a- _L`'........------------- (Complete in Duplicate) - _ �.`�~^' Date Issued I --- --------------------------------------- --------- This Permit Expires 1 Year From 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 Ordinan e No. 549 6 -----• JOB ADDRESS AND LOCATION----- --- �-�---------------•-----------------•--------------------•-•--------------------- ------------ - - -- 1 Owner's Name-------- c Phone----------------•------------------ Address-------- -- ---- ----- -- -----------•----------`- "'"..."-------------------------------------------------------------------------;---------------------- ---•�-------.. Contractor's Name ---------- Phone---------------_------------ - --- - - - ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'❑ Other ❑ i Number of living units: __. Number of bedrooms.-. Number of baths _ .-. Lot size �____f.�---------------------------------------- Water Supply: Public system ❑ Community system 2rPrivate, ElDepth to Water Table A&ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (lfryes,.date_-.--_ New-Construcfion:--YesFHA/VA: Yes y' No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) } Septic Tank: Distance from nearest well------- -------Distan e from/foundation_.-��.....__Mat%iai...�_��/�-__ �� No. of compartments-.- _-_ -_._. `SIZe �`_ Q- ----•Liquid depth_- ----.-'-__Capaci#y. F�____-- �. Disposal Field: Distance from nearest well---— __'Distance from foundations--Ap-._�-----Distance to'nearest lot lines ----------- i Number of lines...- .....�.___......- Length of each line_ - � Vdidth of tre*ch... -..------. / -- Type of filter materiaL,/� .Depth of filter material...l�_-.------Total length-- -.,� --------------------- or Seepage Pit: Distance to nearest well_____--- -----.-Distance fr m f ndafion__AP-----.....Distance to nearest lot IiLp--- ._..r..-.. Number of pits..- — material_ _..Size: Diameter--- ..._-----bepA_A.,�_(ZXK1_.. � Cesspool: Distance from nearest well.................Distance from foundation------------------- Lining mate rial------------------------------------ ❑ Size: Diameter Depth --Liquid Capacity gals. ' Privy: Distance from nearest well.............._._..--------------.-------------Distance fiom nearest-building_---.--- r 0 Distance to nearest lot line------ ---------'--------------------- � `_. Remodeling and/or repairing (describe):-.__- 4____ -----w----------------------------------------------------------------- I ----------- --- -------------------------------- i Y I ------------------------------------------------------------ ------------------------------------------------------"......_.....-._.._....---... ._...-._-.-------------------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules anA regulations of the San Joaquin Local Health District. (Si nedP -------- -- -------- r Con#ractor) 9 )-----------•------------------- }-- - - (�'. Y: --------------- ------------------ ------- ------ Title (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------ -- A^-------------------------------------- DATE----------- 1//7- - ---------- REVIEWEDBY-------------------------- --------------------------- --------- -------------------------:----- -------------------------.- DATE-------------.----------•----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------- ----------- ----- -------------------: DATE-------------------------------------------------------- -- Alterations and/or recommendations:.---4--"--�.� ------7- A---•-•---- 1 ✓ 'c-� ~, �- R Z-__10 I ---------------- ------- -------------------------•------------------------------ --------------- ----------------------------------------------------------------------------------- FINAL INSPECTION BY:-.-- -(2---- --------------- Date--- 9.'-a .-. ' ------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Y 205 West 9th Street ! Stockton,California Lodi,California Manteca,California Tracy,California - t E5 9 REVISED 9-59 3M 3-'63 F.P.DD.