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FOR OFFICE USE; sr ---- ------------------------------------------ ------ l APPLICATION FOR SANITATION PERMIT Permit No. .!._. ..- f_. ._ ----------------------- -- -------------- ------- (Complete in Duplicate) _ Date Issued --------------------------- This Permit Expires 'Year From Date Issued O1 3 —(2,0-56 6 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 inad in�commplianie,with County Ordinance No. 549. { JOB ADDRESS LOCATION--w ' �' >�>; u� --------------------------l � ... . Owner's Name____--C/ __2- ,� - .� - -- ---- = - Phone--••------------------------------- Address----------------- 5,_r.� 2 - .-------------------- -------------------------------------- Contractor's Name--.- . �- -_--. _._ _ .... _ - ------------------- Phone---.-----.--_------.-•__ Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ? _ O Number of living units: ___:____ Number of bedrooms -------- Number -f baths �— Lof'size -____�_.-_r_' - - tir ax,��_______________ � i Water Supply: Public system E] Community system ❑ Private Depth Water Table _____ ft. + Character of soil to a depth of 3 feet: s Sand E] ' 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 SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available"within 240'feet.) - -- ' Septic Xnk: Distance from nearest k ell ..__--__Distance from foundation____________________Material--------ell__� f ,c _____1�1 No. of com artments_._.___________________^Size_- ___�d__ r .l P '� - - --------=------Liquid depth -`�= ---- Capacity---e�'-0-�Dispos Field: Distance from nearest well____-- ---Distance from foundation__y__P�_r_:�.Distance to nearestttllott line_-:.__.Number of lines----- -__-�� '-'Length of eac -line--- �--------r..'--_-.Width of trench----------a--- ----Type of filter material___.eV __.____Depth of'filte'r material __f� __-__ g• Total ler, th------�'� --------- --•---Seepage Pit: Distance to nearestwell----_________________Distance from foundation___________________.Distance to nearest lot line_______.________ ❑ Number of.pits----------------_----Lining material-----------------------Size: Diameter---------------------_.Depth------------------------------------------- Distance from nearest well-----------------Distance from foundation------------ ------Lining material__._..._____________.______._________- ❑ Size: Diameter.- `---------- ------- -----------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy:; Distance from.nearest-well----------------'--------------------------------Distance from nearest building___.______.____________________-.___.____- ❑ Distance to nearest.lot line------------------------------------------------------------------------°-------------------------------------------------------------------- o .eling ing (describe)- -------------------------------- ---------------------------------------------------------------------------------------------- - ---------{----------------------------------------- ------------------------------------------------------------------------------------------------- ----- ----------------------------------------- ------••-------------------=---------------------------------------------------•--------------`----------------------------------------------------------------- -- ------------------------------------ ----------------•----------------- --------------------------------------------------=-------------------------------------------------------------••-------------------------------- I hereLrc-_ert* that I have prepared this application and that the work will be-done in accordance with San Joaquin County ordinancess, and rules and regulations-of the San Joaquin Local Health District-"(Signed)----- --- -- --- -------------------- :---------------- ------------------------- f --------------------- T dl '/or Contractor( -----_-----(Title)---------------------------------- -------- -? -------- ----f----- - ------- ----- --- ---------- ---=---:---------- (Piot plan, showing size of lot, location of.system in ation to wells,.buildings, etc., can be placed on reverse side). A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... a ;_____________________ DATE_______ n__�_____._ -- - ---------------------------- REVIEWEDBY----- --------------------I------------------ -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------ ----------------------- DATE------------------------------- ----------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------------------------------- ---------------------------------- ------------ --------------I--------------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------ -------- r' ___________________________________-_.__----_ _..._-___.-_.________..-___.._._______.._______.__._______._..___________________._ .__. _.__. . ------------------------- ..__ ._._____._.-_________..____ FINAL INSPECTION By:-- -� r'C ----..._ Date - ---------- v� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO.