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FOR OFFICE USE: r G 54. - �f -.------- ►0 ' sI APPLICATION%FOR SANITATION PERMIT Permit No. ._/.� ..... -- ------- ----- I -------- (Complete in Duplicate] Date Issued ----______� y ----------------- r This Permit Expires 1 Year.From Date Issued / Application is hereby made to the San Joaquin Local Health District fora,permit to construct and install the work herein described. This application is made in compliance with County Ordinpince No. 549.0... JOB ADDRESS OCATEON 2 t� r -- ----- . Name----- -----------•-=---------------i---- Phone--------------------------------------- Owner's Address___- W.- ---- --------•-------------------------•-----------------------------•-•--•----•---------------------- _ Contractor's Name-------- --------------------------------------- •-------------------Installation will serve: Residence Apartment:House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other a Number of living units: __.�___ Number of bedrooms ______"Number of,baths t__;------ Lot size _ �X Water Supply: Public system. �ommunity system El Private 0 Depth to Water Table `�--ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ r Previous Application Made: (If yes,date-------------------- No ew Construction: Yes [j- No [&-"FHA/VA: Yes [] No-t-_"' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f ; Sept' an k: Distanc:e from nearest well_________________Distance from foundation__,.________-____--Material-________.___._ __--_-------____________________- s No. of compartments--------------------------Size---•-----------•----------------Liquid depth---------------- -------:Capacity------------------- --- -Disp Field• ;stance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------.-------- umber-of -______umber-of lines----------------------------------Length of each liner----------------------------- of french---------_----.--------------------- Type of filter material-----_-________ Depth of filter material_______________ Total length______________--_____________ __ ______- See a it: Distance to nearest well_""'� __.-_-_--Distance m foundation_l�?f....___.Dlstance to nearest lot lin[ --------- See of pits------t---;------------Lining material--_-l— __.Size: Diameter----6..4...--__-.Depth-.-.�--------------------- Cesspool: Disfance from nearest welL:--------------- from foundation--------------------Lining material_____________________________________ N ❑ Size: Diameter---------------------t------------------Deth------- �-------- ---------------------------------Liquid Capacity --------------- gals. 4 , Privy: Distance from nearest well_______________`-------- -------- ... from nearest building------------------------------------------ Distance -:--- ---------_______________.________-Distance to nearest lot line------= -----------------------•---=--------------------------------------------------------------------I---------------- ---------- Remodeling and/or Fepairing (describe)------- ----------- ----------------------------------- ---•-----------------------------------•----------•-----=------------- •------------- . ---------------------------------------------------------------------i------------------------Y------------- ...I----------------- --------- -------------- -------------=--------•----------------------------------------•--- --------------- --------------------------------------------------------------------•---------------------------- I hereby certify that I have prepared this a plicati and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati n of t San J aquin Local "Health District. (Signed)---------------------------------------------------••-- .(Owner and/or Contractor) b By:------------------------ --- ---- --- ----------- ---- ------------------------------------- 1, ---- - -- (rtlel (Plot plan`', showing size of hst, oc on of sys m in relat� n to wells, buildings, etc., can be placed on reverse side]. 3 i r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------- - - -_ " _-------------- '--------------- -- DATE------ �` -..` a----------- REVIEWED BY--------------------------------------------- -------- -�777, ------ -------------------------------------------- DATE---------------------------- --------------------------------- BUILDINGPERMIT ISSUED--------------------------------...................... ---------_----------------------------------- DATE---------- --------------- ------------------------------ Alterationsad or recommendati s: --------------- ---------•----------------------------•------------------- ---------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ -------- ----------------------------------•---------------------------- ---------- .. ----- FINAL INSPECTION BY:._�!.L�. ---- rAN'JOAQUIN -'rte-- -------- date LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 200 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ManteCar California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CC.