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FOR OFFICE USE: 1 ►7 ------- - ---- ---. ' Permit No. _.....-- 1:1- -- --------- ------------------------ APPLICATION€ FOR SANITATION PERMIT - ------------------ ----------------:-_:- (Complete-in Duplicate) - Date {sued _---_-.-..��--- -------------- ___ 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. 549. JOB ADDRESS cA L CATION--------- - l `°' L� ----------------- ----- ---------------------- Owner's Name--c---- Phone------------------------------------ Address ---------------------•------------- - --------- - Phone....................•-- Address-------•---------`� f ` --------- --------•----•------- t Contractor's Name------. `-�-�-----�- Installation will serve: Residence [�Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Mot 1 ❑ Other ❑ Lot size ---� ° 70 Number of living units..----]-- Number of bedrooms _-� Number of oaths _� --------------------• -----�--- ------------- Water Supply: Public system ❑ Community system ❑ Private [R---9e_pth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe f5--Hyrdpan ❑ Previous Application Made: {If yes,date-_t„--....---..__.) No New Construction: Yes El No FHA/VA: Yes [INo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -' Septic Ta stance from nearest well-----------------Distance from foundation__.----------------Material--------..-.---.------.-------------------------- ❑ � o. of compartments--------------------------Size----•-----------------------•- Liquid depth--------------------- ----Capacity------------------/--- Dispos ie d: Distance from nearest well-> ._ ...Distance from foundation.-_--- d.-_--_iDistance to nearest lot line----------------- .0 Number of lines--------I-------_----------------Length of each line---/tip---_ - .Width of frenc � --�--------_------ �” Type of filter material-- _C-/I'--_:Depth of filter material_-,/�- ---------Total length_-------.-_-------------- --------------- Seepage Pit: Distance to nearest well------------- ------Distance from foundation--------------------Distance to nearest lot line--.-------------- J ❑ Number of pits- ------Lining material-----------------------Size: Diameter----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-- .---.-----.--..Lining material------.-.------.---------_------------ ❑ Size: Diameter-------------------------- -Depth----------------------------------------------- ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well-.------------------------------------------ ---Distance from nearest building--------------------------------------------oe ❑ Distance to nearest lot line------------------------------------ -------•--------•------------------------------------------------• ------------------- Remodelingand/or repairing (describe)-------------------------- ------- ------------------------------•--------•-•--------------------•----------------- ------------------------------------_ ------------------•------------------- ----------------------------------------------------------------------- ---------- ------------------------------- . . ---------------------------------- - -----------•------------------•------------------------------------------------------------------------------------------ -- - ------------------------------------------7 : -----------------•------------•-----------•-------------- ----------------------•------------------------------------------------------------------------------ 0 I hereby certify that I have prepare his app cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ation f the San Joaquin Local Health District. Sined - ----------------------------------------------------------------------------Owner and/or Contractor) ` ----- By: -- - (Title) - - - -- - -- ------- ( � (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR PARTMPNT USE ONLY APPLICATION ACCEPTED BY ��'` f ~" ---------------------------------------- -- DATE l J � REVIEWEDBY---------------------------- ----------- ------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------- ---------------------------- DATE Alterations and/or recommendations:------------------------------------------------------------ --------------------------------•- --- ------------------- --------------" -------- --------------------- - ------ -- --- - --- ---•------------------••-------------------...----------------------------------------------- . —'" - .,,,... . FINAL INSPECTION BY-------- --- - - --- --- -- -------- -- = - ----------- Date-- =`--- -�' ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M 3-'63 F.P.CO. J f