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FOR OFFICE USE: --------- - -----------.-------------- -------------------- ----- - --------- ---------------------------------- APPLICATION FOR SANITATION PERMIT\ Permit No.� � ------- ----------------------------------------- _; (Complete in Duplicated �� 1 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 o. 549. ,��,�j (3 -ufio 32 f c JOB ADDRESS CATION_ �_�_��4 s . / Phone----------------- = Owner's Name i �C, - Address---------+ = r ............. --- -- --- - ------•-- e'_ d�-----_------------ --------- Phone---_-------------------------- pa Name___:______ rx t Installation will serve: Residence [Apartment Nouse ❑ Commercial.[] Trailer Cour} [ Motel ❑ Other ❑ 3 �. 1 Number of living units: /___ Number of bedrooms 4-- Num��D baths -Lot size _ .� =- --- Water Supply: Public system ❑ Community system ❑ Private epth o Water Table _ :___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [[Clay Loam ❑ Clay ❑ Adobe ❑ 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.) z/' Septic ank: Distance from nearest well _:_.._ _____ Distance fro foundation-___1-___-___--.Mat erial----- __ _____ _ __ _________ No. of compartments_.__-_ 'Size-11: j_ Liquid deR p Y th___'_�-___---_. _Ca acit €re.,`g " Dispos field: Distance from nearest well_____ __.Distance from foundation-----j__ =_ __.Distance to nearest.lot line_5-�'___F Number of lines------- -----Length th of each line_______s - y� Width of trench___,�f-' r - Type of filter material_______- /G=—_______Depth of filter material-----------------------Total length___ ---------------------- Seepage _-_____ 1 Seepage Pit: Distance to nearest well_-__--___._•__,-------Distance from foundation--------------------:Distance to nearest lot line_________________ i ❑ Number of pits----------------------Lining material----- .--------- --:_Size: Diameter_---.-------------.----Depth-------------f!'_`_"'"`N----- Cesspool: Distance from nearest well-----------------Distance-from faundat..ion=__.:_ ___---rCining ma#erial___-__-__._.___'_._.___________._.___. I .� _. ❑ Size: Diameter-------------------------------- eoth------------=- - Liquicl Capacity f-----"_---:gals. .�p Privy: Distance from nearest ❑ ' well__.__ _..•- - ____________ + budg__________-___________._..: _'`t-_---._-. _________ ._ sancerom-neares Distance to nearest lot line--------- -------- ------------- -- -t -----------------------�---------------------- �- ------------------ -- ----- - YG�-1 Remodeling a Iring scnbe): l = t ------------- '-=- --------•-------1------------------- - -------- -------------------•------ ------------------------ --------------------- � 11 --------- =- I hereby certify that I have prepared this application and that the work will be drS Ie in accordance with San Joa ui'n'Count q � Y ordinances, State and rules and regulations of the San Joaquin Local Health District. i -� - t (Signed) , "- -------------------------------------- ------- -and/or Contractor) 21 T {Plot plan, showing size of lot, location ole in re ion to wells, buildings,:.etc.,,can.,be,placed on reverse side). r>. 'FOR DEPARTMENT USE ONLY., - �'�- _:='== DATE=r. ------ --------------------------- -------------------------- ----------------------- -- ---------------DATE"- ?-- - ----------- APPLICATION ACCEPTED BY - - f - { REVIEWED BY------------------- ------------ ------- - --------------------------------------------- -- - -- - ---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------•-----------------------------------=``DA•TE------------------------------------------------=---------- Alterations and/or recomme'ndat ions:------------------------------------------------------------- ----------)r,-- , ------------------------------ ---•------------------ ., I ; ---- -------=-5------------- - ------------------------------------------------------------ -------- - ._.. r----------------------- s' -- � ----------- --------------------------- - ---- ------------------------------------------ ----- -------------- -------------------•-------------------------------------------------' Y ' 4 1 FINAL INSPECTION BY:.. - r' F - Date-.- - G---r----'-------------------------------- ------------------ SAN - -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=ellan Ave. 300 West Oak Street 124 Syc6mo e Street . - 3i 205 West 9th Street Lodi,California Manteca,California Trac California Stockton,California y _ I - ES 9 REVISED 8-59 3M 3-'63 F.P.C G.