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FOR FFICE USE: .. { f APPLICATION FOR SANITATION PERMIT Permit No. ..;1. - ._.__-, ---------- ---- Z/` --- (Complete in Duplicate) / -_._____-_ . _ _. This Permit Expires 1 Year From Date Issued Date Issued ____._ 1__�__3.1� Application is hereby made to the San Joaquin Local Health District for a permit to constr`uc'and install the work herein described. This application is made in compliance with County Ordinance No. 549. /- `' JOB ADDRESS A D LOC ION___.__ ____ �___ f r r __.__" Owner's Name- �/,/,-�Xl ---- - - --------------------- Phone �� - Address-------------------••-•-- ----•• ---- --- -- -- - 4--�--------- --------------------------------••-• --------`..------•----•--------•-•--•-----•-•-------------•--••------- ---�•--- -------- Phone--------------------------- --Contractor's Name-------- -- -----' - J�-� --- ------------- ------ � Installation will serve: Residence parfment House Commercial Trailer'Court+ *Motel ` Other {' Number of living units: __ ----- Number of bedroorlas_ Number of baths __r,�'Lo size . /.I, .%'�______________ Water Supply: Public,system ❑ Community system ❑ Private epth to Water Table.V__ft. a, Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sa y Loam El,,, Clay Loam E] Clay E] obe 1C]ardpan Previous Application Made: (If yes,date__.................) No ENew Construction: Ye-s ❑ 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----.-.-------------_-------------..---.--------. No. of compartments------------ ------- -----S ize---�--------------------------Liquid depth---•---------------------Capacity----------------------- Disposal Field/ Distance from nearest well from foundation--------------------Distance to nearest lot line__--__---.-._--__ Number of fines------------------------,Z------Length of each line-----------------------------Width of trench---------- ------ Type of filter material----------------__.__-_Depth of filter material------------------ Total length-...s ---------------------_---_--------._ I. r r �� 4 Seepage Distance to nearest well_ .1 .. ____Distance fpm foundation_ d___�_____.Distance to nearest lot line__________.._ Number of pits_- _ ........Lining mate ria 1--16-4c_�----Size: Diameter ! ----- Depth- '� __. „j Cesspool: Distance from .nearest well-----------------Distance from foundation---.------------- _:'.Lining material - ❑ Size: Diameter-------------------------------------Depth------------------------------ - -------------- - .-Liquid Capacity---•------- -------gals. ` Privy: J Distance-,from.nearest well--------------------------------------------------Distance from nearest building-- t'------------------------------ Z ❑ -.Distance to nearest lot line- ----------------------------------------------------- -------- -------------------------------- ---- ------------------------------- Remodeling and/or repairing [describe) ?:. - '' ------------ f 1 _ .�_ �—I ___�_ i ----------------------------------- - -- -------- 1 ------------------------------------ ---------------------------- - ---------- , - ..........-----------....---------------------------------------------------------------------------------------------------------- 1 I hereby certify have prepared Aisrapplication and that the work will be done in accordance with San Joaquin County ~ ordinances, State laws rules nd ulatians ofAe San Joaquin Local Health District. (Signed' i � _-_ 1_.._____ _F___. (Owner and/or Contractor) -------------- --- -- BY= -- ----------- F. ------------------------ `(Title) - . plan. showing size of esl� cation of system in relation uildings, etc., can be'place on�rev.r-,e side). ! _ I FOR DEPARTMENT USE ONLY �. / APPLICATION ACCEPTED BY -- = 1- . - -- ------------DATE-------- -- �' t f REVIEWED BY----.------- -----------------------"` - - ------- ----------------------------- DATE --- BUILDING PERMIT IT ISSUED SSUE --------------E-`----------r--._--------------`--------------t-- -- :--------{----- C-- -- -------------,--.-.-._DATE ..`.--`--�--.--�•r`-=----C-�-----`--------------------------- --------------------------------'-- --- datios: -�-------Alterations and r6 en � '-{ r ........ -------------- = t-- iC, f t!/ 1 . --------------------------------------------------------------------------------------------------- -----•---------------------------------I- ----•-----------_------------------ --------------------------, ---------------------- ----------------------------------------- ----------- ------------------ Y i �a FINAL INSPECTION BY:...`- `7� --------------- -----cz-�"-�-�----- Date------ - / ------ C SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 aM 3-'6n C.P.ga. . i