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FOR OFFICE USE: ----------------- ------------------- -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. .__..1 - ---------------------------------------------------- --- Duplicate)(Complete in Du cate ( p P 1 pate I-ssued ---------------_,---------------------------------------------------- This Permit Expires-1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constry t and install the work herein descpbe� This application is.made incompliance with County Ordinance No. 549 r d/ 670• D f "-------------- JOB " ADDRESS AN LOCATION Owner's - Owner's Name----- - ------ ------------ -----------•-•----------------------- ---- --- --------a------------------------------- Phone---------•-•--------••-------------- � t Address * ...d ---------- s fPhone------------------------------------ Contractor's Name--- ------ •------ - Installation will serve: Residence []/Apartment House E] Commercial `❑ Trailer Court ElMotel ElOther E] l Number of livingunits: _ __ Number of bedrooms —3- Number of baths _�lLot size ____ :_ t Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [�ay Loam ❑ Clay ❑ Adobe❑ Hardpan [I i. , Previous Application Mader {If yes,date"...................) No F-1New Construction: Yes [] No ❑ FHA/VA: Yes ❑ No E]. TYPEIOF INSTALLATION "AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: distance from nearest well DI5#ante from foundation._ __MatenaL"_..______-"_""..__"-"------"----_...."_""_"".. ❑ No. of !compartments-----------------------------Size..-----------------------------..Liquid depth-------------------------Capacity----------------------- l_ �' Dis osal field: Distance from nearest well-- vT6"_..__Distance from foundation.___1�.�.__._.Distance to nearest lot li ............. �. p . �- Number oft lines________ Length of each line"_.__I",�-E1-.-__---._.Width of trench."_ �__________________ Type djilter,maferial___," t_Depth of filter material_.__.. _f_____...Total length_____ _3V--------------------------I� I Seepage Pit: Distance-to-n-earest-well_"" "�� `' D.istance from foundation----_---------------Distance to nearest lot line----------_------- Number of pits + � --Lining t = en'al --------------------Size: Diameter----------------- -----.Depth------------------------- ---=--- r Cesspool: Distance from nearest well- __-3----Distance from foundation----_____"_____.__.Lining material-"__________________________________ [] Size: Diameter------ ------------------------- -{-Depth-------------------------------=--------------------Liquid Capacity------------------=---------gals.( I • r ,Privy: Distance from nearest well---:�-:-----;---------------------- _--,--- .Distance from nearest building----------------- -------------------•----V' Distance to nearest lot line rte" � " I r . remodeling and/or repairing (describe):----_. � 1 d � ----------------------•--------------- --------._...---------. ------ --- - ----------•--------------•-------------- ---------"------------------------ I ------"--------------•-•-----------------•--"--------------------------------------------- --- - . -- .� - � " ----------------------------------•------- --------- A I ' 'I hereby certify thaf 1.have prepared this jp1j, ion and that the work will be done in accordance with San Joaquin Count ordinances, State laws, andLie'sand regulatioh San Joaquin Lacal Health District. Si ned ---------------------------------------------------- ( wner and/or Contractor(..g ) -or ----- OBy----------------- -- - ----------- ---r:; --------- --------- n_. -----------------------------{rtle)---------------------------------------------- - - --(Plotplan, showing size of lot, locationof'syster in relation to wuildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED_ BY-- -------------------------------------------------- DATE - ` ----------------- REVIEWEDBY----------------------------------------------- --------------------- ---------------------------------------------------- DATE----- •-------------•-------------------------------- -- BUILDINGPERMIT ISSUED---------------------------------------------------------------__ ---------------------------------- DATE----------------------------------------=---------- -------- Alterationsand/or recommendations------------ ------------------------------ ----------•--------------------------------------- --------------•----------------------•------------..------------ •---------- - --------------------------------"-------------------------------•-------------------------------- -------------------------------------------------------I------------------------------------------------------------------------------------------------------------ ---------------------------------------------- --•---------------------------------------•-----------------------------------------•-----------------•------•-------------------------------------•-•---------- -------------------------------------------1----------------------- -------------------------- -------------------------------------------------------------------------•----------- ------------------------------- --------------------------------- ---------------------=------- � FINAL INSPECTION BY ! � � ----- - ------ Date-J. --------------------------------- ---------------------------- SAN -- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 DEVISED 6-59 3M 3-'63 F.P.CO. -