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ff.//yf FOR OFFICE U E: . -� - j �3 �' Per No. 1 Dov APPLICATION FOR SANITATION PERMIT --------- --- ----- (Complete in Duplicate) Date Issued ___ - --------------- 3 --------------- This Permit Exl2ires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to const ct and instals work herein described. This application is made in compliance with County Ordinance,No. 549. ._ �- JOB ADDRESS AND LOCATION________._ _. •-•---------- ------------ Phone-/j-/=-----�--•---- ... � Owners Name—------ Address--------------- .---Address--------------• -----------•-•'7 .. ==.�-------•-------- -- i Phone ----------------------- Contractor's Name Trailer -- --- - -----•--------------------•------•-•-------•--..__...-------••-- , Installation will serve: Residence ® Apartment ouse ❑ Commercial ❑ Trailer Court [I Motel C3 Other ❑ Number of living units: . -.-- Number of bedrooms __If:7 Number of baths ____ee Lot size .-__..__ • `.... Water Supply: Public system (g Community system ❑ Private C] Depth to Water Table- Clo t Adobe❑ Hardpan C3Character of soil to a depth of.3 feet:%, Sand-❑Gravel ❑ Sandy Loam❑ Cfay Loa j� Y ❑ Previous Application Made: ''(If yes,date---------------------1 No [ , New Construction: Yes Q( No ❑ FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: ..t (No septic tank or cesspool permitted if public sewer s;available within 200 feet.) Distance from foundation _..___.Material________ ...v.. Septic Tank: Distance from nearest well____. ----• - -. Ca aci �..-.-•-•••• No. of compartments---•--- i'J------•--Size__..7Xr= , --'r .Liquid depfih--•------- .. . p ty-- •- Distance from foundation.__..3..-c'----•Distance to nearest lot line------- �... ti Disposal Field: Distance from nearest weH._- ---•- z�_----____-__ ® Number of lines------------- --/-- Length of each line-------•----rSr�- Width of trench.----•----------•- g Type of filter material,_�� ---Depth of filter material____�.jV-_'----- -Total length------.......�'__�_.................. Seepage Pit: Dis#ante to nearest well__-___f- _------Dista ce from foundation___..) .p-_.Distance to nearest lot line :-� --- Number of pits___-_____-yr---------Lining material__` I Cesspool: Distance from nearest well________________ Distance from foundation--------------------L`ni d Capacityel-•-----------------------------gals. ❑ Size: Diameter----•---------------------------------Depth-------------------• -•-----•-------------------- q --------------•--- ---••-- Privy: Distance from nearest well---------------------------------------------- Distance from nearest buildin9------------------------•-/•----- ❑ Distance to nearest lot line__________________________1--------------------•-•-------...-------••---------- -----•---•----------------------------•-------------•------• , Y = ------------•------•---------------•---- I Remodeling and/or repairing (describe)_-------------------------------------a --•--•------------------------------•-------------------• ---•-----••---------••------------- •-----------•-------- c I hereby certify that 1 have ared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and r s an regulations of the-San Joaquin Local Health District, (Owner and/or Contractor( • - ••---• (-- 1 (Title) Sy:----------------••-----•---------•--------• ---------- ---------on-• -----ell buildings etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in rela+ion to wells, FO DEPARTMENT USE ONLY ------------ rz' .......---------- DATE----------• l>� G I APPLICATION ACCEPTED BY___-__- ___- ___-_ ..� ---- - I REVIEWED BY------ ------------------------------------------------ ------------------------- -------•----------------------•- ------•---------------- -------------------- DATE------------------------------------------------------------- BUILDING _---•-•------•-----------•------------•--------------•------ BUILDING PERMIT ISSUE ---------------------------•- -----••----•--------- Alterations and/or recommendations:____-_.-_.__-.._.-._ _ ------------------- --------- ---------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------- --------------------- ------------------•-- ------- -------•---•------- FINAL INSPECTION BY--- ------------- --------- - --- ------ Date-------- -- )--. _�. _ / - --- k SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 4th Street 130 South American Street TracCalifornia Stockton,California Lodir California Manteca,California y, E6 9 REVISED 6-59 214 6-61 AtLAg i