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FOR OFFICE USE: _ ------------------------- ---------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. .1_7-...2.5 ----_---------------------------------- (Complete in Duplicate) ✓r Date Issued --------------------------------------------------------- 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 herbed. This application is made,in compliant with County Ordinance No. 549. oS8-- 6am-3 2� If JOB ADDRESS AND OCATION ____ �; - Owner's Name'_.____ ..- _L].� Q.�?- C�- r.�. ------- -------------- ------- Phone - Address......--- -{` `� / = �_ Contractor`s Name *c: x �- k_lt '"---•-------------------•--- Phone-----_----------------------•------ K' - ... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I__ Number of bedrooms __,_3Number baths .- Lot size ______________________.______________.__.___..______._____ Water Supply: Public system ElCommunity system Elivate PrDepth to Water Table _ -___ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote___________________) No ❑ 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 200 feet.) Septic ank: Distance from nearest well__ ___- Dista �e f;om f�oundation__.W�-----__...Material----._.__. � +� N No. of compartments_---_ ----.-_.__Size . __ _ - _--Liquid depth------ ... Capacity..,. Dispos Field: Distance from nearest wel-., '______Distance from foundation---1-t--F.__._�Distance to nearest t line.___-__'.____ <. la,f Number of lines._____.____ _____ Length of each line#► ___S _jf -_ -.Width of trench_c2 __.�. _________ Type of filter material- Distance to nearest well _-_--Distance from foundation--_-/�__--..__-.Di tante to nearest loEline— ---___• V' El44 Number of pits------ ----------Lining material__-T-+s�__;-------Size:�5--- -� .-f_Depth_.9---- -------------------- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material__._-___.___--_---.----_-_.__---___. ❑ Size: Diameter----------------------- ------ ------Depth------------------------------ ---------------------Liquid Capacity- ------------------------gals. :m Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building-_-_--_----_-_--.-.-- ____-..-_----- ❑ Distance to nearest lot line------------------------------_------------------------------------------------------------------------------------------------ ----------- N . Remodelingand/or repairing tdescribe)------------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------••------•-----------------------------------------------------------------------------------------------------------------------•--=--------=----------- Z� ---------------------------•----------------------------------------•------.-......-----------_-.-----------------•---------.--.----------•----------------------------- ----------------------- ---------------------------- ------------•------------------------------------------------------------------------------------------------------- -------------- - I hereby c§PN jr that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S et"s, and rules and reulations of the San Joaquin Local Health District. (Signed)------ -_ -----------------P---- = ----------------------------------------------------------------------------- rad/or Contractor) ,By:_- !----- # _..... . . ' �_ ----------------------------------------- ---(Title)-------------------------------------------------- ---_ --------- (Plot plan, showing size of lot, location of system in r lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ ------------------------------------- DATE------�� 6- -G --------- REVIEWEDBY----------------------------------------------------------------- ----------------------------------------------------------- DATE---------------------------------- BUILDINGPERMIT ISSUED---------------------------------- -------------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------ --------------------------- ------------------------------------------------•-•-----------••---------------•------....---------------------- ---------- -------- •-------------------------- ---------------------•---------- ------------------------- -------- ----------------------------- ---------------------- -------------------------------------------------------- ----------------------------------------- ------------------------------------------- -----•------------------- ----------------------------------------------------------- - --- ---------------------------------•-----------------------------------•--- ------ ---------------- ----------...----------------------------- FINAL INSPECTION ------------------ 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 Tracyr California ES 9 REVISED 8.59 3M 3-'63 F.P.CO.