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F R OFFICE USE: — '— " z� y � _-'________ _____� -v APPLICATION FOR SANITATION PERMIT Permit No. ----------- ------ {Complete in Duplicate} - ----------------- - -------------------- -- 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 Ordinan eN . 549. JOB ADDRESS AND LOCAT€ON__. . -______ ---------•---••--------------------------------------•-------------- Owner's Name---- -' - ---... Ph ----- lone Address-----i .__ --- _ ---------- ..----•------------ •--- . r- Contractor s Name-_______ ------------ ---------------- I ------ r- - -• Phone Installation will serve:� Residence [i Apar merit House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I � _ Number of living units: --I____ Number of be ___-7_1Numtr of baths ___L Lot size E 1 y .--------- Water .Supply: .Public system M-1--6ommunity system ❑ ,Private ❑ Depth to ater Table 4--rt. Character of soil to a.depth of 3 feet: Sand C] -Gravel ❑ Sandy1oam Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ ' Previous Application Made: (If yes,date-----_-------------_l No New Construction: Yes No ❑ FHA/VA: Yes ❑ No'[GJ� TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic T k: Distance tfrom nearest well- �_____Dis#ante from foundation__- ---------Material .--______ ET No. of com artments_ - p --------- --'Size__. ' __ 1 i '�- Liquid depth- ----- ------Capacity ---- --a .� . . �II Disposal Field: Distance from near e f well________ _______Distance from foundation-JO to nearest lot line___4�._-______ iL �� Number of lines________ ______________ Length of each line____9 '__.*3 _F .Width of trench-__ -------_-- - Type of filter., ----__Depth 'of filter material__t--_.__-__ _._ - r � -' __Total length- --f-�--------------------•----- Seepag Pit: Dis#ante-to nearest well_-" ------------ Q Distance from foundation /0 to nearest lot line_ ____________ Number of pits__. , 'Lin ing material1___"T_T6_Ck.-Size: Diameter____ " ! Depth . --------------- 1_ Cesspool: 'Distance from nearest`well______________ Distance from foundation--------------------.Lining material-------------_- --------------- V1 ❑ Size: Diameter -------- =--- Depth----------- I --------------------------- Liquid Capacity_---------------------,- gals. Privy- _ .,*41Distance from',nearest well--------_.:' - _.---- i------------.__-____----_Distance from nearest building ❑ Distance to nearest lot line-------------------------------------------------------------- Remodeling -------------------------------- -Remodeling and/or repairing (describe)_________________________ _ ----------------------------------------------------- --------- --- ----------------------- ------ -------------------------- ------------------------------------ ------------#------------y--- -------•- v -y------------- -- �_�- ----- -- - '------:--- ------=--------'-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County '~ ordinances, State Ia s, and rules and regulations of the-San.J quip Local Health District. r (Signed) ,� Contractor) gr---------- -• - ------•--- ------ -- -- ------------------------------------------(Title}------------------------ ........ ......... (Plot plan, showing size'of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCI PTSD BY-- ..c`e - -------------------------------- ---- BATE �j ------------------------ REVIEWED BY - `' -------------------------- ----------------------- DATE = BUILDING PERMIT ISSUED --------------------- --------------------------- ------------- Alterations and/or recommendations:_-- -� ----- --------- --f'-y _ --- ��-----••-------••---------- ------------------------------------------- r OS - --------------------------•----------------•-------------•----••------------------------------- dd k 4 -----•------------------------ ---.-. _ .� --------------------------------------------------------_--•-----`- ------------------- i ' -'__._-- FINAL INSPECTION BY-------------14.-:- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CC. , -