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FOR OFFICE USE: ---------------- ------------------------------------ -- �(�> � APPLICATION FOR SANITATION PERMIT Permit No. ..... .... ------------------------------ ------------_.:----------- (Complete in Duplicate) 7s Date issued --- --�---- --- --�° ----------- ------------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for s permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - ct JOB ADDRESS AND LOCA ON.. �± " e ��C/ 8-+->rJ Owner's` Na -- s --------- -- C ------------------------ Phone-------------------•----------- Address------ ------------ Contractor's ---------- v �2 ---------------------------- Ad Contractor's Name----- -- ------- -•- =------------- ----------------------------------- ----- Phone----------•---------------.-------- 4. Installation will serve: . Residence Apartment House E] Commercial ❑ Trainer Court ❑ otel ❑ Other ❑ , `Number of living units: ________ Number of bedrooms __fes_ Number f baths._/___- Lot size _____ __ _______ _______-_.._________.____ -------- Water Supply: Public system ❑ Community system ❑ Private Depth / ater Table3�_ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ .� aI , Previous� Application Made: (If yes;clate-.._ :Y .._'.-} No ❑ New Construction.: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ %A r TYPE-OF INSTALLATION AND SPECIFICATIONS- 4 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { f Se ti ank: Distance from nearest well_:- -0--- __Distance from foundati n____._ d.__....Material_______ ____________________________________ p r No. of compartments-------- -Size-! e ii f 2 ....�---�_ ..�--Liquid depth...... •-----------------CapacitY---�----- Dispo Field: -Distance from nearest well_:!-�Ar---Distance from fou dation_____© _ __---____.Distance to nearest lot line --/-------r Number of lines_______,_______.________: �Length of each -- --- -- of french----s .____-./________________ r Type of filter material__. ,,- Depth of filter material------ __.----- otal length,______ ---------------------- vs Distance to nearest well._.____iD Distance from fo ndation_____1_l1__-_____-D)stan/ce�to nearest lot li _X--------- G ' ❑ Number of pits.._.-----f-----------Lining material-- :---- ----- Size: DiVmv1v,_,2 _X---16----_--Depth--.j ----------------------- f Cesspool: Distance from nearest well__I_____________Distance.from foundation----------____._...Lining material-------------------------------------- M �] # Size: Diameter--------------------- ---Depth-'-- Liquid Capacity-.--------------------------gals. Privy: . _ Distance from.nearest well_._____'_____________________________________Distance from nearest building-------------------------------------- -- ❑ Distance to nearest lot line--------{ '------------------------------- --------------------------------------• •------------------------------------------------------- ` Remodeling and/or repairing (describe):--------- .,----------------- ---------------------------------------•----------------------------------._---------------------- -------------- i ------------- Z i= = `- --------------------------------11/_--------------------•-------------------------------------------------------------------------------------------------------------- ,. . _ ----- ------•------------------------------------------------ . ------------------------ ----------------------------------•---------------------- - 1 hereby certify that I have prepared this application and that the work will be done:in accordance with San Joaquin County ordinances, St laws, and rules an regulationThe-San Joaquin Local Health District. 1? (Signed}.. --- ------------ - ------- ----- -----------------r------------------------- nd/or Contractor] ------ BY:-------- ' ----- -- ----- ------ .- -- - -------------------------------- it le)-------------------------------------- - - (Plot plan, showingRsze of lot, location of system in#`e�atio o wells,,buildings, etc., can be placed.on reverse side). - FORTEPARTMENT USE ONLY APPLICATION:AtC>=PTED BY t '---------- ---------------------------------------- DATE----- l4__ --------------- ---------- REVIEWEDBY - ---------------------------------------------- DATE----------------------- -------------------- ----------- 1 BUILDING PERMIT ISSUED------------------------------- - - - ------- -------------------------- --•----------------------- DATE---- ----------------------------------------------------- Alterationsand/or recommendations-------------------------------- ---------••------------------------------------•--•---•-------------------------------------------------------- . i ------------- -------------------------- ----------------------- ------------------------------------- -------------------------- ------- -------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_. Date--- - "G��' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 r.P.CO- 7