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FOR OFFICE USE: ----------------- ---------------- ---- --------- APPLICATION FOR SANITATION PERMIT Permit No. ... _ _��...... (Complete in Duplicate) / .: Date Issued ..-•----(�-�- -�-�---• -.-.__------- --------------- ___. This Permit Expires 1 Year From 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 No. 49. i [3 °4s A), 4-" ° b�S- a 2-0 —3-0 -------=-•---- ---- ------------------- -------------------- ------- JOB ADDRESS AND LOCATIONy�--- - ------- - ------------------------------------------•-------------------- - Owner's Name----------- ._.11 ►fPhone------------------------------------ Address > _ _... �� .�slI -� -- ---------------- Phone----------------------------------- Contractor's Name--------- Installation will serve: Residence I] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __vim__ Number of baths _L_____ Lot size _____ I -cam'•--------------------------- Water Supply: Public system ❑ Community system ❑ Private.$ Depth to Water Table 6_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 93 Clay ❑ Adobe ❑ Hardpan-Etj 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:) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------ El .__--..--________--_--- _________-------.-___-_❑ No. of compartments---------- ------- ------ Distance from foundation___Z -----------Distance to nearest lot line--- ------- Number of lines------f--------------------------Length of each line-----Xa--------------.Width of trench---- -`�- -----I Type of filter materi -_Depth of filter material___: 9`°_____._Total length- r -d___:____________________�_ � I ! . `Pit: Distance to nearest well--_/A----_--_-_Distance from foundation-_. 4t__..-_..Distance to nearest lot line_1�--______� --- a- Depth. 1fQ- �!. Oil Number of pits#.j_______________Lining material _ 6 _._ ___ Size: bl�me#er_ I Cesspool: Distance from nearest well_________________Distance from foundation____=-----.._..____ELining .iquid Capacity_...___.-. __-_______.__._gals.( V 1� Size- Diameter- --- -------- -- - ----- ---- -De th---------------- - �4 Privy: Distance from nearest well---------------------------------------------------Distance from nearest building_______-_.------____________--____.__-.-.� ❑ Distance to nearest lot line--------------------------------------------------- ------------------------------------------------------------------•----------------------- 1 Remodeling and/or repairing (describe):__wA04 a�--------------------------------------------------- NI - --------------------------------------------------------------------------------------------•-------------------------------------•---------------•---------------------------------------------------------- ----------------------------------------------------• ---•------------- ----------------------------------------------------------------------:-------------------------------------•--------------------------------------- 1 hereby certify that l have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, S1_4 laws, and rules and regulations of the San Joaquin Local Health District. (Signed} ----I t ----------=----------------------------------------------------------------------------(Owner and/or Contractor) -ono--�#• -^'^'-- ------:.�- --------- '-. --- ---- - ----- (Title]--= ---------------------------------------- --------- I (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 ACCEPTED BY----.� s -----------------------------------•---------------- DATE---- r ------------------------------- REVIEWED BY--------------------------------------------- ---------------------------------------------------------------------- -------- DATE-- ------------------- -------------------------•-------- BUILDING PERMIT ISS ED �.A�TE------ --- - ---------------- -- • •- ------•--------•-------•-•------------------------------- --- ------------------------------------------------ ----- ------ - -- --- -f ------------- FINALINSPECTION BY---------------------------------------------------------------- Date- -------------------------------------------------------------• -------------- 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 ES 9 REVISED 8-59 3M 3-'63 F.F.CO.