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FOR OFFICE USE: u �F APPLICATION FOR SANITATION PERMIT Permit No. . .._... ---------------------------------------- --------------- Date Issued -s, --------------- ------- --------------------------------- (Complete in Duplicate) / 3 / - -------------------------------------------------------- This Permit Expires 1 Year From Date Issued _._.�j�� ....��.•-. Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. " JOB ADDRESS AND CATION,ft-E- -- ....... .. .... Owner's Name ---- ---•-• -- - - ------- . P -----------------•••-- --- hone . Address----------- -�•J0-r--•- •--- ------ -- -�►.... --...........------------ --.__'-•-_-----.. 6 / / Contractor's Name...... ...... .-` ------ --------------------- Phone. ......... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ //Motel ❑ Other Number of living units: --- Number of bedrooms -:3-Number -baths I.. Lot size ....L�� --------•- Water Supply: Public system ❑ Community system [I Private epth to Water Table _____. ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam F] Clay Loam Clay ❑ Adobe❑ 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation_______________---. ------------------------------------------------- No. Matena ___------------ -- --- ----------- No. of compartments_------------------------Size--------------------------------Liquid de th__---____-.-_--_-.__--_-_Capacity Dispos Field: Distance from nearest Distance from foundation_.._✓ ._____.Distance to nearest lot t Ie_._ __...__ (T1 Number of lines------------ ___.._________ Length of each line----- y-_-y_ t Width of trench_r�-._.____/ Type of filter material----A,�_.._.' .__Depth of filter material_ G�` Total length-----a -----.-----O b 49��- Distance to nearest well__ .__�_ ___-__Distance from f undation----f_ ....Distance nearest lot line .... ❑ Number of pits---_...-I-----_ Lining material;/ Q -_..Size:4NawwtRr.A`./x-_-�Q--Depth-------lcaR .4-------------- Cesspool: -----------Cesspool: Distance from nearest well---------------•-Distance from foundation--------------------Lining material--------------.._-.__-_--__-•-_------ ❑ Size: Diameter-----•--------------------------------Depth--------------------------------------------------Liquid Capacity----------- -------------.-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------____-. 9 ❑ Distance to nearest lot line------------- ----------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------------------•-------------------------------•------------------------------------------------------------------------------• . -------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------•---------------------------------------------------------•---------------------------------------------------------------------------------- ---------------------------------------------••-- I hereby certify that I.have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Stat laws, and rulejadregulafloils of the San Joaqu' ocal Health District. �. % .,�1I,i,,, ,------ - - .and/or Contractor) (Signed) e t By:-------- Y '�Ilessssr (Title) ------------------------------ - (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -1 ---------------------------------- ....................� .3..--------------..----------- -------------------- ---�- REVIEWEDBY--------------------------------- ------------------------------------------------ ------ DATE------------------------------------------------------_ _ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- -•------------•--• DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ...------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- --------------------------------------------------------------- •--•----------------•------•--------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------•------------------------------------------- ------------------------•-------------------------------------------------------------------- ---------------------------- ------- ------------------------------------------------------------------------------------------------- -------------------------------------------------------------- -------- FINAL INSPECTION BY:., Ie4 ----------------- Date-- -� 'Z - �i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CO.