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FOR OFFICE USE: ------------------------------------- ------------------- --------------------- - - - - - - - - - APPLICATION'>�-SANITATION PERMIT Permit No. s�`�._'__.�. -------- N -------------- ---- --------------------- (Complete in Duplicate) ---------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the SanA Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance wrlf<?t� -` unty Orddinin`ance No. 549. JOB ADDRESS AND LOCATION--- A dei'---11.---- Owner's Name-------------------------------------( --------------------------------------------------------------------------- Phone--- - -----y�- y Address............................. 4----P.'.... 11 11..3..----------------- �� Contractor's Name----------------------------------------------------------------------------------------------------------------------- Phone--•--- ---•-----------•-•-------- Installation will serve: Residence [3--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l.... Number of bedroom _ umber of baths ---L Lot size ------- -_----------------- Water _______________________ Water Supply: Public system ❑ Community system [ Private ❑ Depth to 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 Pa'—New Construction: Yes ET'�Jo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION, AND SPECIFICATIONS: /�Iao �V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well__--__ Distance from foundation-----/!;�--------Material------ '0?c_________________________________ [r]� No. of compartments------------[�------- _..Liquid depth-----q<"z.- -------Capacity..f_aJ`G...... Disposal Field: Distance from nearest wce�ll_.___ f ._Distance from foundation---o�._. ........ to nearest lot line----S�_ ®'' Number of lines............e,C______------------Length of each line---------4�-_________.Width of trench-------- :_•_--_---_---_---_-- Type of filter Depth of filter material___-__ ------Total length----------Il -C)__________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation.........-..........Distance to nearest lot line----------------- El Number of pits.-..------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: ______________________ ______Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- . ElSize: Diameter------------------------ -------------Depth----------------------------------------------------Liquid Capacity.........................---gals. Privy: Distance from nearest well ----------------------------------.-------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----- ----------- -------------------------------•------•--------------------------------•------ --------------------------------------------- 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, State laws, and rules and gulations of the San Joaquin Local Health District. �1 (Signed).+t .Cs'�- ------- -----------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------- -------------------------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR 5PKARTMENT USE ONLY �] APPLICATIONACCEPTE ------- -------------------------------------------------------------------------------------- DATE-------- _z._760--{ REVIEWEDBY----------------------- ------------------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT IS ----------------------------------------------------------------------------------------------------- DATE--------------_----- Alterations and/or recommendations-------------------------- ----------------------------------------------------------------------------------------------------------_------------ ---------------------------------------------------------- -------------- ---------------------------------------------------------------------------------------•-----------•-------....................................... -------------------------------------------------------- ------------------------------------------------------------------:--- ---------- -------------------------------------------------- ---------------------- ------ ------ ----------------------------------- ---------- ---------------------------------------------------- FINAL INSPECTION -- --•-1 ------ - -- Date--------- -------- ------------------------------- AN AQUIN 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 95 9 REVISED B-59 3M 3-'63 F.P.CD.