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FOR OFFICE USE: Z�� `� -------------------- --------- - APPLICATION FOR SANITATION PERMIT Permit No. -- -. (Complete in Duplicate) ---------- ----------------- ------------------- ------ l f� - Date Issued ------------- 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 Count� Ordinance Nobi�4 � /�{ - 3 SCc � JOB ADDRESS AN LOCATION a''`- Owner's Name-------- � ------ �-J--------1- -------^------ Phone-----•------••-----•--'- c --------•---- Address , -.--- ---------------------------- ------- Contractor's Name- -- ------ -- ---------•--- ------------------------------- Phone-------- Installation-will serve: Residence Apartment House [I Commercial ❑ Trailer Court F] Motel E] Other E],t" Number of living units: --- _. Number of bedrooms ."Number of baths .!.__ Lot size -----------------.--_"_"_"__-"-__"__________________________ k Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. r Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay El Adobe J"Hardpan ❑ Previous Application Made: (If yes,date.....:..............) 'No ❑ New Construction: Yes {❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic ank: Distance from nearest well__.��--------Distance! from found ion._. _-Q__--.____.Mai rial_._�Lcys.�Ga� --------------i•� No. of compartments_____:_"� ------------Size_ _ Yq"_lb"_p""" Distance to n Capacity""I .C�O ' _Li ,id de th------ Disposal Field: Distance from nearest well_ .E15----- ....Distance from foundation 1 ti earest lot line, � (� Number of lines------ -„- --- -- -------------Length of each line._ C? .j'F�.....Width of trench----`z---------.---------------- Type of,filter material. -Depth offilfer,material_""" �-______.__"""Total length-----�(plJ_.___"""__- """"-..------- Q Seepage Pit: y . .Distance to nearest.. _____.._____.'Distance from foundation_________________".Distance to nearest lot line_________.__.-.. n ❑ Number of pits-------f-------------Lining material---------_-------------Size: Diameter__------------------Depth-----------------------------_- -0 I Cesspool: Distance from neare'# well-----------------Disfance!from foundation-_"._______--t_.Lining material"_________________"""___--_-""" -. ❑ Size: Diameter---------4---------------------- ----Depth: -; _, -:----Liquid Capacity----------------------------gals. �l .. _ ¢ C � Privy: Distance from nearest.well------..-_".............:.. ------Distance from nearest building"_..-..._______._______------------------. -� ❑ 4 Distance to nearest lot line --------------- --------= ----- --------------------------------------------------------------------�•�}� Remodeling and/or repairing (describe)-_ ---------------------------------------------------------------------- •--------------------"------------------ ----------------• --------- ------------------------- C+ -••--------"----------------------- N . _ -------- _ .� ___""-""._.._--i_'-__l__-________--"-"_______ -_""_---_"""____--""__"_ .______._-._____...___.___________._____.___________.____________._.__"._..________..____.._____-__.____.___._"-_-_ -_________ __ ____ _ _____ 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 and regulations of the San Joaquin Local Health District. Si ned _ -- --- ------ d/or Contractor) ( ig ) --- --------- , L (Ti+le)---------------------------- _ (Plot plan, showing size of lot, location esystem inr ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _ ,_ ---------------------------- DATE--� � .. ---------------------------- - ----- - - -- -- - --- ---------------------- REVIEWEDBY------------------------- - ---------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ----------------------------------. DATE------------------------------------------------------------ Alterations and/or recommendations:-------------------------------- ----•---------------- -----------------••----------- ------ -------------------------------------------------------------------- ------------------------------------------------- ---------------------------- ---------------=•---------------------- I 1 - /_ 7.7 P FINAL INSPECTION BY:--- --------- Date.f/. _. zk�� r - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California ` Tracy,California £S 9 REVISED 8-59 :3M 3-'63 F.P.CD.