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FOR OFFICE USE: �� 617 ------------------------ ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. . __4..d3.�'___ (Complete in Duplicate). y ��- ~ - • 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 ins#all th ork herein described.This application is.,made.in. co liance with County Ordinance No. 549. O `=L-CEO- d3 JOB ADDRESS OCA ON _Z_ ?*�.-: � � ---"�o - ---- .. -_... Owner's Na ---- - - - -----------------•--------------- -------- --- --------- Phone.. Address:_= I�-�! - � "f= ----------------- Contractor`s Narl�t-•--- --- !4' c" Phone Installation will serve: Residence 11Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _.____ N r g umber of bedrooms_ Number baths -_f__ Lot size _______ -- - --------------------- t :. 4 Water Supply: Public:system ❑ Community system ❑ Private K- Depth ater Table -------- ft. Character of soil to a depth of 3 fe'4 . :S'and E] Graver❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dcite_� ----_..)—No 0•—New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'.if public sewef is available within 200 feet.) ��Septic ank: Distance from ,nearest well_________________Distan a from foundation__-_.-l�._.____.Material-_-__---___...--._.___ _.___________. r h.. /, --------------- 6-- No: of,compartments-'---.1.�.__._____- --Size-- --.1�__, ---X.-:_--Liquid depth---- -----------------Capacity__ -_----- --- V -i,i, - Dispos Field: Distance from nearest well_., -_____Distance from foundation_____/_D-i.._.Distance to nearest log IineS _.__ .._,--� 7 Number of lines"- '-'_-r-^ -- ---Length of each line- dd- A_-D_Width of trench___.`-__3- _--______-- ,Type of.filter 'material_=______ ._____•_Depth of filter material____.____,,—_---Total length-__-________ _ P g f its----------------------Lininmaterial----------------- ----.Size: Diamete.r---------------- ------Depth----- ------------------------� Seepage Pit: Distance to pits wel-----------------------Distance from foundation--------------------Distance.to nearest lot line----------------- + Number o g Cesspool: Distance.from nearest well..:-_: =":'___Distance from foundation___-----------------Lining material--------------------.,_____.__.______ acit , I s - ❑ Size: Diameter-------------------------- ---.Depth------------ --------------- ------------ - Liquid Ca P Y--�---------------------=---9aJ Privy: Distance from tnearest well-,-_-__.1Distance from,nearest building----------------_____.___.__._.___-___..: Distance to nearest lot line_____________________ ! Q—7t� -------------------------- Remodeiin and or re airin "'descrikie '__:___ C! ------------------------------------------------------------------ • ------------------------ -------------------=--------------------------------------- ---- --------------------------------------------- s 1 ----------------------------•----------------------------- --- ----------- -----------•• ------------ ------- --------- --------------------------------------------------=--------------------------------------- = =--_= ------------------ -------_---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin C3unty ordinances,xinglasize. , and rules and regulations of the San Joaquin Local Health District. } O' /or'Contractor) (Signed) BY= 4 ------------------------(Title)---------------------------------------- (Plot plan, of lot,.locatitiqosstem.in re ion to wells, buildings, etc., can be placed on reverse side). _ �t FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY-- --------------------------------------------------------- DATE------ R' �' -------------------{ REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE----------------------------_----------------------------- BUILDINGPERMIT ISSUED--------------------------------:-------------------------------------=--------------------------...: DA-TE------------------ ---------- ------------------ --------------- Alterations and/or recommendations:-- ------------------------------- -- -------..-----------------------------------------------------------•--------- ------ . ------------- ------------- ---- ------------------------- ---- -----------------------------------------------•--------------------- FINAL INSPECTION BY -_✓_ , ------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT • C i 7601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .t ES 9 REVISED 5-59 3M 3-'63 F.P.CO.