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FOR OFFICE USE: _______________________ -----------------_-__--____--4.j APPLICATION FOR SANITATION PERMIT Permit No. -------------------- ---------------------� (Complete in Duplicate) Date Issued ______ -_ 4 __________________________________ ,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 des i d. This application is made in compliance with Couriy_Ordinance No. 549. �c et..+^✓ JOB ADDRESSAND OCATlO.N_._._ Owner's Name_ � � --- ----- Phone------------------------------ - Address-----�- t..- Contractor's Name ,' -----•--- ---- ---- ---- Phone . .. - —0 11� W Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ � �r i H Number of living units: ___ __ Number of bedrooms,._._ Number of baths _/___ Lot size _` 1c '1�_-_-_____________________iNl- o�f Water Supply: Public system ❑ Community system ❑ Private ~Depth to Water Tablet"ft. x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: lIf yes,date--_-__-__..___..___l No [P. 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 240 feet.) Seta 'c Tank� pee from nearest well________________Distance from fou ndation__.________�____ _Material___._______-_____-.____.______.____-_--_I / compartments--- -------------------Size-------------------------------Liquid depth:--------------- ---------Capacity--•--- ---------------- f /` -- Disposal Field: Distance from nearest well_-��___Distance from foundation/p�___-,____+_.Distance to nearest I` line�,�._____ Number of lines________ Length of each line__ s� Width of trench.-,;P - -------------------- f rA_-Depth of filter material _-- --.Total length ,1 _�ype of filter material-A � Seep�t Pit: Distance to nearest well-------.----------.---Distance from foundation------_--._._.___.Distance to nearest lot line----------------- Number of faits-----------------_---Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia}__.__--.------------------------------ Size: _-_----- .-__-_-_________- Size: Diameter_---- -------------------------Depth_`-------`-.--------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _'-------------- ________?______-----:__a..._Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line-----------------------------------------r +`------------------------------------------------------------------------------------------ - Remodeling and/or repairing -(describe)----------------------------------------------------------------------------------------------------A& . F' I --------------------------------------------------------------------------------------------------------------------------••-------- --------.:..:-------------------------------------------------------------------------- - --- ------- ---------------- ----------------- ------------------------------------------------------------------------------------------------ ---- ------ - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations pf the San Joaquin Local Health District. _____. or Contractor (Signed) ----•---- - - ----- ----- l( ,I ) ------ By:---------------------------------------------------------------------------------- -- ---- ------(Title)----f7 / (Plot plan, showing size of lot, location of system in rela ' to wells, buildings, etc.,.can be placed on reverse side). ORD TMENT USE ONLY APPLICATION ACCEPTED BY--------- — ---------------------------- DATE-----------------� - - _ ----------- REVIEWEDBY--------------------------------------------- ----- -------------- ------------------•--------------- •----------------------- DATE_.---------------------------- ---------------------- ---- BUILDING PERMIT ISSUED_. DATE . 1 DATE------------------------------------- -----------•----------- Altest� and/ recommendations------------------------------------------------------------------------------------•-------------------------------- ------------------------------------ ;1 _._. ._---- .___- ---------------- r� I. - - - --------- - --------- --------- -------- ------------- FINAL INSPECTION BY:............... ------- Date----------------- / 3 - -------- ----------------------- 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 1 ' ES 9 REV45E0 8-59 3M 3-'63-.F.P.00.