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OR OFFICE USE: � _ 3...-------- APPLICATION FOR SANITATION PERMIT Permit Noir /----3------------1 .,- ------- (Complete in Duplicate) ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date 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 AND LOCATIO ----- -Q oZ--------- Owner's Name-.,,--.- -------------- ame = •. ��. ----- -- --- - --------- .- honer -- / �� Address--------i5l-- �-' �'%' ' �' - - f- ---- �....-- ----- Contractor's Name--------- --- - ------ -------- ---••------- ------ --- Phone----------------------••----- installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_-_ Number of bedrooms zP� Number of baths / ,� _�, .-- _ --- ------------------ ___ Lot size __._ ___ ___ Water Supply: Public system g Community system ❑ Private ❑ Depth to Water Table Ilir$_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p ' nk: Distance from nearest well_________________Distance from foundation-------------------Material----_----------.-___.__-_-.-_---__.-.-.------.--. i No. o€.compartments'- -------------------Size--------------------------------Liquid depth-------------------- ....Capacity---------------------- 13 geld: Distance from nearest well,, _-.-Distance from foundation,--,/O_. _.--_Distance to nearest lot line-.-�-----__ N Number of lines---------/ ---------Length of each line�_�- =W._____--.Width of trench.--:27 __. ,�------ ---�------- �Type of filter material_ _-_5r_Depth of finer ---Total length ..e __-_ .__.-.______ 'P Distance to nearest well-17 -AW om fo ndation__ _ �.�-------Distance to nearest lot iine__.�..______ Ir Number of pits------_ .- Lining material_ _ ___ —_Size: Diameter---- . .__-.---Depth---- _3--------------------- G Cesspool: Distance.fi-om nearest well-----------------Distance from foundation--------------------Lining material__.--._-__,____-_-._-.__-_- ❑ Size: Diameter--------------------------------------Depth----------------------------------+----------------Liquid Capacity-----------------------------gals.Vt Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- 4- ❑El Distance to nearest lot I;ne-- ----------------------------- ----------'------------------------------------------------------------------------'-----------------------411110� Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------'----------------------------------•------------------- I ------------------------------------------------------------------------------------------------------------------------------------------ -------- ------------ --------------------------r------------------- ------ ---------------------------------------- ----- ---------------------------------------'-----------------------------------------------------------------------------------------------------•---------------•-------------------------------------------------------------- ----------------------�-.------------------------ ----------------------------- ----- -'------------------------------•---------------------------------------------------------------------------- ----------- - I hereby certt,fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Stat aws, and rules and regulations of the San Joaquin Local Health District. (Signed)-,---- �' . -- -- --------------%.- --------------------------------------- ----- wner and/or Contractor ------------------------------•------------�P-4-70--ti.--- - -. --- -- ---�---A—- -----------------------------(Title)------- - ----------------------------------------------- By: (Plot plan, showing size of lot, location of system in relation 9 wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------------------------- j / DATE------- Q.r �a ----------------- REVIEWEDBY-------------------------------------'------------------------------------------------------------------ ------------------- DATE------------------------------- -----------------_--------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------'------------ -- Alterations and/or recommendations:------/'-.1-�r~-6- - Q.r1--- �r_ -------------------------------------•--------------------------I .. -----------------------------------------------------------------------------------------------------------------------------------------------'-------------- ----------•---------------------------------------------------- FINAL INSPECTION BY:------- - Date.-.' Q!� --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazelton 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.P.CO. E`\