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FOR OFFICE USE: ---------------------------- r€ , APPLICATION FOR SANITATION PERMIT ':; Permit No./ �s�..�.� ._ Zi ' ------- -- --- (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. 549. JOB ADDRESS AND LOCATION--- - ------------------------------------------------------------------ - �'Z�- X,------------------- ---- ------------------ - Phone.-- -----------------•------•---- - 61 Address Owner's Name_�Address .-+ -• � -- -- ------------ mow ' ,----- j(-. : '---------------------------------------------------------------------------•------- Contractor's Name - -------- --- --------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [Ij/ Trailer Court ❑ Motel [- Other ❑ Number of living units: .. Number of bedrooms Number of baths .,? Lot size .......... ..........._...-----.__...______--__.___._.__..- Water Supply: Public system ❑ Community system E Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay 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 200 feet.) Septi ank: Distance from nearest weil.....00c _f__.Disfance from fougdafion............. Material__-e-!e��-u-�......- No. of compartments... � -..... ---Size._.,3�--�--�..------- Liquid depth----�-.......- - ---• _CaP Y--?� acit - --=- Dispos Field: Distance from nearest well_ .. -------Distance from foundation..-/4:__`.__.____-.Distance to nearest lot line'.-_-____--- Number of lines--------------I----- ------------Length of each line------- �`- -------Width of trench--->-........----...------------ - Type of filter material___.__ /(---------Depth of filter material----_1Y__............Total length- ----------------------------- Seepage - --------_ .-__Seepage Pit: Distance to nearest well________--------------Distance from foundation-----------------_Distance to nearest lot line...-._____._... ❑ Number of pits----------------------Lining material----_._--. .. ---------Size: Diameter_. ..--------- -- -._Depth---------------------------------------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation____ _____________ Lining material.. - --- -------------- El Size: Diameter- ----- -- --------------- ---Depth-- - ----- .. ....Liquid Capacity ------------ ----- - -----gats. 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 1 ordinances, State Iaws,_and rules and regulations of the San Joaquin Local Health District. (Signed) ~�and/or Contr------------------- - --- - -------------- actor) .\ 8Y= ------ `-- �--�= _�`.�.{.. - {Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. _ ;- __,- -- --- --`-• ' ---- -- - -------- ------------------------------- DATE----%�-------------- REVIEWED "- ... BY---------------- ------- ----- --..... -----------------------"----------------. DATE-------- ------ BUILDING PERMIT ISSUED------------- ----- --------- -- -------------- ---------------- ---------------- --- ---------- DATE.---------------- ---------------- -- Alterations and/or recommendations:...---- ------------ FINAL INSPECTION BY:---/ .:.. ... ....-_ ate.- •-' � -- ---- -- - - ... ------------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30D West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy, California ES 9 REVISED B-59 3M 3-'53 F.p.Co,