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FOR OFFICE USE: `4 7 0 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. � ----------------------------- --------------------------- (Complete in Duplicate) % k 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 herein dek4bed. This application is made in compliance with County Ordinance No. 549. �J JOB ADDRESS A LOCATION_.1 ! _ .Z. "•--ta --•--•-- -fSfleR------- Owner's Name..... --- --- --------------------------------------- --- - ----- ---- --------------- Phone..................... --•••- 1. Address------�3.Q--- J ----- ----- ............................................ • - Contractor's Name------- - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ T,railer Court ❑ Motel ❑ Other ❑ Number of living units: __t✓____ Number of bedrooms _ Number f baths ____ Lot size _.__..._ ----- Water Supply: Public system ❑ Community system ❑ Private Depth Water Table ________ ft. Character of soil to a depth of 3 feet: Sand❑ _Gravel ❑ Sandy Loam [?Clay Loam ❑ Clay ❑ Adobe❑ Hardpan❑ Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIdHS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well...._------------Distance from foundation--------------------Material------------------------------------------------- No. of compartments Size................. Liquid depth ______-__-_Capacity❑ P q P� 01 Disposal/Field: Distance from nearest well P Y ,S_0 ___DistanceJrom foundation .9 Distance to nearest lot�line--- ........ Number of lines----- --------------Length of each line------ _._::Width of trench.__3.__y_____________ ____ Type of filter material__;�X____-___Depth of filter material__,=_�f_--_______-Total length-------6-0........................... 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--.----------------- material_____-____-_______-_______-____ -- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-___________________________-__-- ,-_---_Distance from nearest building---•---------------_________ ________ ❑ Distance to nearest lot line- --- --------------------------------------------------------•------------------------------------------- •--------- --------------- O Remodeling and/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 ordinances, SLlaws, rules and regulations of the San Joaquin Local Health District. (Signed)----- -- - ---- ----- --------- --------------------------------_---- ---- Co tra tor) n cBy• ---- ---4---------- - --- --- -- --- ............................................(Title)---------- ---- ----- ----- -_- -------- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. - -------------------------------------------------------- DATE b-'` r L y REVIEWEDBY------------------------------------------------------------------------ ---------------------------------------------------- DATE-------------------_------- .............................. BUILDINGPERMIT ISSUED------------•--------------------------------------------------------------------------------------• DATE-------------•-----•----------------------------------------- Alterationsand/or recommendations----------------------------------------------------------------------------------------------•-•-------------------------•--•------------------------•----- -----------------------------•-------------------------------------- --------------------------------------------------------------------------------------------•-------------------------------------•--••-••--------- --------------------------------------- ----------------- -------------------------------------------- --------------------------------------------------------------------------------•-•----------------------------- ------------------------------------------------------------------• ------------------------------ -----------------------------------------------•---------- --------------------------------------------------------- FINAL INSPECTION BY _--- - ^"' ---------------------- Dated 3 ' �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:olton 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. +dam:.;- •.c