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C U t* . = � - 3 �/ - ��- - t: APPLICATION FOR SANITATION PERMIT Permit No. _. .._ ---- ------- -- ------ (Complete in Duplicate) '"/' This Permit Ex fres 1 Year From date Issued Date issued _.-� r'--- Application is hereby made to the San Joaquin Local Health District fora ermit to construct and instal(the work t This application is made in compliance with County Ordinance No, 549. . rk herein described. JOB ADDRESS AND LOCATION.-- Owner's - _ ,. ----------- � Name _ --r --- --- .a:_ Address , ------ Phone F '� 3' -------- ------------- Contractor's Name______ --- ------- -----••------------•---- -•-----------•---- G1. ---------------------------------• - Instapation wil! serve: Residence [� Apartment House E] Commercial -------------------------- ---`--- Number of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ /_-___ Number of bedrooms`3-- Number of baths .__-__-_ Water Supply: Public system ❑ Communif system Z Lot size Y Y ❑ Private Depth to Water Tablet Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Previous Application Made: (If yes,date--------------- ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No New Construction: Yes ❑ No L�FHA�VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within Q feet.) Septic Tank: �bistence from nearest well_____________ _Distance from foundation-------------------- ❑ No.j of compartments----==----------- Material.------------ ------------------------ . Size ............. Liquid depth Disposal Field: Distance�fi•om nearest well.-_-_ ,. , ------------Distance from foundation_----"--------------Distance to nearest lot line-- ------- -• Number, of. lines-._-�_"":�^-:.�..�.� Length of each line_._,______-_____- x.Type.of.filter material- ------- - - ------- Width of trench-------------- " {. t # ,Depth of filter material-----------------------Total length--__---_--- Seepag it: Disfance to nearest well i ----•---- - F - -`-.-------__Distance from foundation__/4_- _--_-_Distance to nearest lot line.___ ' _- i Nurriber of:"pits.------------- - Lining ri»aferial_�-p_�- . - _ Cesspool: ----Size: Diameter___ _9_-----Depth_-c,�,5-- - I p 'Distance from nearest _w ------ _`_Distance from foundation______________ - ❑ r Sizei'.Diameter-_____ ---- -----.Lining maferial____. x -----------------------Depth------------- ---------------- -- s - Liquid Capacity_._. Is. Privy: Distance from nearest.well -____._------ --____--_ �- ' -____--__.-Distance from nearest buildin ELS ❑ �. ,Dis"tance to nearest lot, line------------------`_._____" s 9 -------- � s _. ` � r --------------------- Remodeling and/or repairing (describe):---_"....________._ ' _ � l"� L --------- ; 1 ----------------------------------------•---------•------ --------------- _ - -----------------------------------------------------------------------------------•--------------------------------- I hereby certify that I have prepared this applica}ion and Lha}the work will be done in accordance with San Joaquin County ordinances, Stat s, and ru s nd regulations of the San Joaquin Local Health District. )� (Signed)--_ ----------------------- --------------------------------- BY ---- -- caner r Contractor)---------------------------------------- (Plot (Title} and/o Con or) plan, showing size of lot, loc n of system in relation to wells, buildings, etc., can be �� placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- .__-- �_ ----------------- REVIEWED BY ------------ ----- DATE //• !• -------------- ------ DATE---- UILDING PERMIT ISSUED----------------- �------ ----- _ -------------------------------------------------------------- - ------------------•-- ---� A terations and/or recomme dations: -----_. -- 'ATE -.-`- �� +- z_ ------------------- --- `- _ �a l"y l ---------- FINAL INSPECTION BY. _.:- - S Date_ / f_ ---- j SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ! f124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California 65 9 REVISED 8-59 3M 3-'63 F.P.CO. -