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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..lS`"�p__._ (Complete in Duplicate) 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 described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS ANDCATION__ _ ---- -=------------- -Owner'sTName-:--- P}lone Address--------------- - ------- -- ---------�q' ----------------------_ Contractor's Name._. - -••-- ------ - -------� ------•------------------ ----------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: _ _____ Number of bedrooms Number f baths __ ot size .__- :°____ ____�__r.-_ P _____________________ Water Supply: Public system ❑ Community system ❑ PrivateDept o 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 ❑ Nb ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) q p p-- Y----- - Septic nk: Distance from' nearest well---xe___--Distanc? from fpyndat�on______�_ ._r.. Material---- . --____. No, of compartments-----�______________Size�.�___�'JC.'___��__Li uid de th__.__�._.___.________Ca acit ��Q_" I i Disposolield: Distance from nearest weiL_--..gaf_Distance-from•foundation-----/____---------Distance to nearest lot line ------------ Ed ________ _ Ed Number of lines__________,____ --- Length of each line______0_�-_._e`__ _-Width of trench--__�___„�_'_'------------- Type of filter material-__ ___..___Depth of filter material-------P -------Total length-------- ____________________ Seepage Pit: Distance to nearest well-- a----------------Ristance from foundation---------------------Distance to nearest lot line................. a ❑ Number of pits---------------------Lining material-----------------------Size: Diameter----------------____--Depth---------.----- ----.. i Cesspool: Distance from nearest well-----------------Distance from foundation--_----------------Lining material--------------------- Size: Diameter--------------------------------------De th--------------------------------,.'"'`------------Liquid Capacity gals. Privy- Distance from nearest well------------------------------------------------- from nearest building----------------------------------------_ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------__---------------------------------------------------- � Remodeling and/or repairing (describe)-_ _:_ .-_ ___ -----------------•---------------------;-------------------------•------•------------- ---------------------------..... ----------------------------------•-------------------------------- -----------------------------• ---------------------------- ---------------------------------------------------------•---------------------------------------------:=---------------------------------------- I hereby certif I have prepared this application and that the work will be' done in accordance with San Joaquin County ordinances, State caw , nal rules and`regulations f the San Joaquin Local Health District. I - - - --- ------------------------------------------------------------ ------------------------------------------------------------- and/or Contractor (Signed)------------------ - � .— / ) By:------- --------D---- --- -------------------------------------------(Title)---------- ----------- ---------------- -------------..._.-.__.. (Plot plan, showing size of lot, location of system in relation + wells, buildings, etc., can be placed on reverse side}. A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--,A e- ------------------------------------------------------------- DATE----------------------- `------- REVIEWEDBY------------------------------------- ------ -------------------------------------------------------------------------------- DATE-------------------•-------- • • -- - --- BUILDINGPERMIT ISSUED----------------$------------------------ ------------------------------• DATE------------------------------------ Alterations and/or recommendations:; --------------- } ----------------------•-•------------------------------------------•----------------------------------------------------- ----------------------__------ '--------------------------------------------------------------------------------------------- --------- -- ----------------------------------------------------------------------------.- --------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------•-------•----------------------------------- ------- i ------------------------------ ----------- •---------------- -------- -------------------------------------------------------------------------------- --- I ----------------------------------- ---------------------------------------•---------------- ----------------- -------------------------------------------------------------------------------------------------------- R ------------ _ Date----- f �. � ------------- - - - - FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazeiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.Co.