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FOR OFFICE USE: -------------_-------_-----------_---_--- ------------- APPLICATION FOR SANITATION PERMIT 1 Permit No. .----71-------- --------------------------------------------------------- (Complete in Duplicate) Date Issued ... _ -------------- - ---------- ------------------- This Permit Expires 1 Year From Date Issued pwor 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 AN O ATION,I- __IA4 .... j6 Lam' Owner's Name. ••-•--•------- Phone%!!/• /fir ?, ----- - ----------------------- Address -------- . •--�-• •--• --- -- - ----------� -•----. ............................................. Contractor's Name.......... ••. -• •---- �•----- -- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: F- ---- Number of bedrooms _ Number o . baths . Lot size ...----- ..�1�� Water Supply: Public system F-1Communitysystem 171 Private epth to ter Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] ndy Loam Clay Loam E] .Clay E] Adobe F] Hardpan ❑ Previous Application Made: (If yes,date--.________________) 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.) p Distance from nearest well_. 0_____Dista `from foun�lation.___.l ______.Materi�_______________________________•-_-.------------ --- -- Se tic nk No. of compartments--------- jSize_�_.____.-X/10;OLiquid dept__...________________Capacity.._ Od�G�Q Dispos Field: Distance from nearest well-__e ----Distance from founda,t}io�n......1�----__.Distance to nearest to I%er�__....... Number of lines_______ � r _.... .___ _ Length of each line_. !_'_ p-6W�Fd..Width of trench__ _ -_ Type of filter material ,e____.__s___.Depth of filter material_._.. _.______.__Total length____._ .._.Q_______________________ Seepage Pit: Distance to nearest well._ -------_---------Distance from foundation....................Distance to nearest lot line----__-_-_--._--- �. ❑ Number of pits----------------------Lining material--..--__-._.__.-.__.___Size: Diameter------------------------Depth---------------.................. �^ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__---_-______-----_-___--_-:.__-----. ❑ Size: Diameter--------------------------------------Depth---•------------------------------------------------Liquid Capacity---------------•----•-------gals. Priv Distance from nearest well-----------------------------------------------__Distance from nearest buildingD Privy: ---•-------•------------- -•------•-•------------------------- ❑ Distance to nearest lot line---------------------------------------•----------•a•--•-------•--••---- 0 Remodeling and/or repairing (describe)_________________ '` ------------------------------------------------------------------------------•----------------------------------------------------k"--------------------------------------------------------------------------------- ------ -------------------------------------•--••---•-------------•-•---•----•---•----••---•---••------•-•-•••--•-----------•----••---------------------------------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------ ..............................-----------------------------•----------------------------------- 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, r les and regulations of the an Joaquin Local Health District. (Signed) ---- --- --------- - ------------------------------------- ----- __ caner-and/or Contractor) B ----------------_- -•-•------------------•--- ---------- ---- -- �---- �- Title Y ---- (rifle) ----------------- ------------------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, build ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _ __ _ ___ DATE__y_�Y._G,wl. REVIEWEDBY------------------------- ------------------------------- ----------------------------------------------•_------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED.............................................................._....................---••------------- DATE.............................. -------_-------------------- Alterations and/or recommendations---------------------------- ------------------------•-------------------------------------------.------------•------------------------------------------- ------------------------------------------------------------------------------------------• --------------- --------------------------------------------------------••--------------_ ---------------•---••----- ----------------------------------------------------------------------------------------------------------- ------------------.................. -----------------•------------------------------------------------------- FINAL INSPECTION BY:--:" ' ------------_---- Date------...../.J�"�� -------------------•-•------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.CD. 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