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# /OROFFICEUSE: { y Permit No. . ��--____-- - APPLICATION~ FOR SANITATION PERMIT { ------ = -- (�----------------------- (Complete in Duplicate) / -------------------- Application ------------------ r ` __-_-.-._-___.-._-._._ This Permit Expires 1 Year From Date Issued Date Issued _____ __ �p.y 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. 549. JOBADDRESS AND LOCATION.......��--•W,5 ------------------------------ - ---------------------- ----------_-------------- Owner's Name.. 2ft E--•- ---- ----------- ------------ ------------ ------ PhoneO _ Address----------------------------------- ------------- --------------------------•--------------•---•--------------------------------------------- ---------------------------•------------------------- Contractor's Name--------�•--- --- -------- ----------- Phone.. Installation will serve: Residence P' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I.__ Number of bedrooms --- Number of baths '1 Lot size _- 2 - ........... Water Supply: Public system ❑ Community system ❑ Private/9 Depth to Water Table _4*� 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 E] No kV FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic �TTaffnk;. �- _� Distance from nearest well-----------------Distance from foundation_.-------___--------Material--------------_.__.-------.---------------------- ❑ G� No. of compartments--------------------------Size----------------------------:---Liquid depth--------------------------Capacity---------------- Disposal Fj : , Distance from nearest well__.-_.._Distance from foundation. �___.Distance to nearest lot line_SM.___. '� Number of lines______________�___ _.___ Length of each line------- _.______ __-.Width of trench._----_.�t`� ._.____z..-_---_-- G Type of filter materia k �--Depth of filter material___-`-------Total length------------------ Distance to nearest lot line... i Seepage Pit: Distance to nearest well__/�''�...____._Distance�,rof�qfo� undation___��-.._ -.�----- ��/� Number of pits-_----/'-_----------Lining material, Size: Diameter------C�--.__.Depth---.__ ------__-- 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-.-.-_._--_---_-_-_--______.----------_. ❑ 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 regulations of the San Joaquin Local Health District. (Signed)------------- - �syystem ----------------------------------------------------------------------------------(Ow rand/or Contractor) BY� ------ ------------------(Plot plan, showing size of lot, locationation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ '�-=: DATE = / f REVIEWEDBY-------------------------------------------- ---------------------- ------------------------------ ------------------------ DATE_-------_------------------------------------------------ BUILDING PERMIT ISSUED--------------------•- -- --- DATE------------ -------,----------- �+ Q Alterations and/or recom endations:--- -'-5----`-----loA---------)------ ___4A imk----•------ �, �'t �' ------ i _._..._ ---------- ---- __---------------------_-----------_-_-_-_-..-_..._---•-------.---•------------------------. ---------------------....._..--------------------........___...'_ -------------------M-M---------------M-...................M-----------M--------M---------M-------------M.......-------M---------------------MM.............. _-.....................................................................................•-.-.----._._.----.--____.....-_--_-_-----.-_-__----_-_-----_........___... -----------------------------------------------•--.--..---.-.--.--_------_.---.----_----.-_•_-_..-..-_-_-_____•.-_.-.---•----__--_---.-_---_--.._---.-----.-_-_--.--_----. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.---- ---- ---�`y'.------ Date------------...........---------- ----------------------------------------- S;;N 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.CD.