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OR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...r------°d:--- � ----" -- -------- --------- --------- -------- (Complete in Duplicate) __________ ___ This Permit Expires 1-Year From Date Issued Date issued --- ----------------- ------ --- -------------- l 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 Or finance No. 549. Q� JOBADDRESS AND,L/OCCA�TION___ U_..__ ----"--------•----------------------------------------------------••-••----------•---------------------------- Owner's Name-------------/_-� -----l.:_._ ' ` , ------ ----------------------- Phone Address - ----------------- •------------------------------------------------ --------•---------------------------••------ Contractor's Name------------------ t S S •- ------ Phone----------------------------------- Installation -- -Installation will serve: .Residence [l Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units:1_____ Number of bedrooms _3__,_,.-Number of-baths _L__-_ Lot size ____________________________________ Water Supply: Public-system [�__Commuriity system ❑ Private ❑ Depth to.Water Table _`p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ffT`1'iardpan ❑ ' I Previous Application Made: (If yes,dote____________________} No W`�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.) Se t' T nk: Distance from nearest well__-_��____Distance from foundation__/4._____.__.:.MateriaL�-_ -_______-_______- I d No. of compartmenfis..._�2________________Size__..�,]�,�r�_7""-:_--Liquid depth �------------"-"---:Capacity_- --- _-_. - Disposal Id: Distance from nearest well..:...............Distance from foundation-1-4.... Distance to nearest lot line. ___________. -Length of each line---' Width----------•_----Width of trench_. _K------------------ ----- w Number of lines___. ___----- �� <• `f -- Type,of filter material___Rit�f_.__-____"Depth of filter material_ _ Total length____��:C�-___________________ - -- r S`` - oa Pit: Distance to nearest well_.__---"'7—�__Distance from fo a'tf n____ �_:___:___.Dist��ce to nearest lot line---------------- Seepage g -- _.___Linin material__�� fife: Diamete --.- ---------Dept ❑/' Number:of pits------------- 9 � , h------- ------------------• V Cesspool: Distance from nearest we __—_— __ Distanc�rom foundation__________________ Lining material ___.____________-_._____________.___. Q � ❑ Size: Diameter--------------------------------------Depth'-- _ Liquid Capacity gals. C J Privy: Distance from nearest.well----------------=---------------------tz-------Distance from nearest building------------------------_-------------- Distanceto nearest lot line--------------------------------------------r--------------•--------- ------------------------------------------------------- ------ N Remodeling and/or repairing Idescribe)------------------------------------------------------------------------------------------------- -------------------------------------------------------- 1 ---------••-------------------------------------=-----------------------------------------------------------------•--------------------------------------------------------------------------------------------------------- -----------------__-------------- --------------------------------------------------------------------- --------------------------- ---------------------—--•p------------------�p------------------------------------------------------------------------------------------------------------------------------ I herebycertifythat I have re ared this a Lica on an hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o f he Sa oa quin ocal Health District. (Signed) ------------ ---------- £- ---------------------------------------•----------------- (Owner and/or Contractor Plot Ian, showing size of lot, Iota to s st""" to lation to ells, buildings,_ " (Title)_________________________________ __________---_----_.-.--_--.. ( P g etc., can be placed on reverse side). -, FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY------ ----- DATE ��' - -------=------- r, REVIEWEDBY--------------------------------------------- ------- --- ------------------------------------------------ DATE------------------------------ --,-- ' BUILDING PERMIT ISSUED---------------------------------------------------------=--------------------------------------- DATE------------------------------------- ------- --------------- Alterations and/or r comma da 'ons:_ ___-__--_ _ _______________________________ �?''-----4 .... & 4 Al C,." " -------------- --------- " l '� - -- '- -- ----------------------- ----- FINAL INSPECTION BY:.. �CC�e Date--------`--------------- �r SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.HaxeHon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street i Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.120.