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FO OFFI SE: : E ,1 t _ _ t _________________ 3 APPLICATION FOR SANITATION PERMIT Permit No. ! t1__�l ---------------- ------------- r --------- ------ --------- l •�. (Complete Com lets in Duplicate) Date Issued --------------------------------------------------- ------------ ------------- ---�-- ---- _.-...- This Permit p Expires1,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. 549. r JOB ADDRESS AND ^'LOCATION --!----- 4�_Iv�--S.--..... , '------------------------------ Owner's Name......... �� / ------._ .. _ ---------- Phone - Address--------------------- . 3 �� / ��+vFy --------------- -----------------------------------------••------------------ - -- - -- ------- Contractor's Name-=- --•---- - •--- •-----' •-------••- '=--_='---""---------------------------» --------------------------------- Phone----------------------------------- Installation will serve- "Residence [}_partment House ❑ Commer`ciaM Trailer Court j❑ Motel ❑ Other ❑ Number of living units: -----.Number of bedrooms -___ Number_of,baths _-- Lot size___ ,1 ____________________________ Water Supply: Public system Er-'Eommunity system❑ Private ❑ . Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Q 'Sand Loa`mn,❑ Clay Loam 0 Clay E] Adobe ardpan ❑ Previous Application Made: (If yes,date---.--------------..]� No New;:Construction Yes []j No iA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i . f.; --(No septic tank or cesspool permitted if public sewer-is available within 200,-feet.) �VI Septic Tank: Distance from nearest well_________________Distance from foundation_______________.__ Material__----___-------___-_---._..__-.--_-___..____. ❑ No. of compartments-------------- -----------Size-----------------------------_�Liquid depth_-------------- --------Capacity---------- -�----- Disposal Field: Distance from nearest well_________________Distance from foundation--- lbi?stance to nearest lot line____.___..... r �/ t/�/1/�JNumber of lines-_-________I_._..-D�___-___Length of each line____��___2_----_._.:-Width of trench.___ � _._.__.____ I/,�f.Type of filter material____.` ________.__Depth of filter material___ d'_/.__._Total4ingth-------�l____________________>__. Seepag Pita• ^ Distance to nearest well______________________Distance from foundation---/�._�_.Distance'to;`nearest lot line__.5_�______ J �i Number of pits_i-----1_------------Lining material____ .Size: Diameter_,,33-------------Depth----p�,�__ --------------- - Cesspool: Distance from nearest well-----------------Distance from foundation.__._.__._.-____..Lining material-------------------------------------- ❑ Size: Diameter-:-t-------------------=--------------Depth---------------------------- ------------- -------Liquid Capacity----------------------------gals. Privy: Distance from 'nearest well_________ . isfance from nearest building___---__--_--___________..__._____...._. Distance to nearest lot line rte - ---------------------------------------- 11 Remodeling and/or repairing (describe}----------- --- --- - -- -- ----- ---------------------------••------------------------ ---------------- --------------------------------•---------- -------------- ------------------------------------------------------------------------------------------------- - ------ -------------•----------------------------------••------------------------------------------------------------------------------------------------------ ----- I ! --------------------------------------T--------------------- -•-----•-•--------------•------------------------------------------------------------------------------------------------------------- -- I hereby certify-fI have p i aced this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rule an'd ulations of the San Joaquin Local Health District. fi (Signed) ----------------- ------------------ ------------------------------------------------------- ------Owner and/or Contractor By:---------------------- -- -- ------ - ---- ---- - (Title--- ---Z`_7 _..-......------.-- (Plot plan, showing s' a lot, location_of_system_in..relation.fo,w.ells,-building s,-etc., can-be placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I . � �---------------- DATE--------� ------------------- i --- _____________ - DATE --------------------•------------ REVIEWED BY =-- -------------- ------- - ---------------------------------------------- BUILDING ---------------- ------------------ BUILDINGPERMIT ISSUED-------------=--- ----------------------------------- ----------------------------- ------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:____'`_._-_`"'_...- _s- ----` --__ --------------------------------------`"' ' ` - -- - -------- . "' /O �' ! �----- --- ----- •----- -- ---------`: - = - _ --------------------------- ----- -------------- -•-------- ----------------------------.:.--.---------------------------------------- - ------------------------------------- -------------- , r ------- --------- ------------------------------------------------------------------ FINAL INSPECTION BY:--- -.... GL'.�'---------------------------- ltd__ . . 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 E5 9 REVI5t:0 8-S9 3M 3•'63 F.P.CC.