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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..C... ..7------ (Complete --Com lete in Duplicate) This Permit Expires 1 Year From Date Issued 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 L CATION__.-.?Jc...... ^ 41_-;/ ?. ------- - ------------ -------------------------------------------------------------------------- Owner's Name.... ..... ------------------------------- ------ - -- -- -- --- - ---.-...... Phone------------------------------------ ?r'd ------------------------------------------------- - Address-------------------� _..,.-----� - ------------------ ---------------------------- -------- -•-------------------------------- -------- Contractor's Name------------- -' 0 Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: i,L_ Number of bedrooms Number of baths .iL__ Lot size _-J2✓_Xlle'7------------------------------------ Water Supply: Public system (Community system ❑ Private ❑ Depth to Water Table Z 4. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D—"Hardpan ❑ Previous Application Made: (If yes,date....................I No 2?,' New Construction: Yes ❑ No [!- FHA/VA: Yes ❑ No Z;— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi c Tank: Distance from nearest well-..--------------Distance from foundation-----.__----.------Material-----....-......---......---------- ............ Axfol i J No. of compartments----- - ---- ------------Size--------------------------------Liquid depth---------------- ------Capacity------ ............... Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_..-_-..-_-_.-_-_ Number of lines-----------_----------------------Length of each line-----------------------------Width of trench------------------_-----_------- Type of filter material-------------------_--_Depth of filter material_--------------------Total length---------------------------------.-------- qj Seepage : Dp _ __ Distance to nearest well______________ __ -Distance from founciation_ �_,�-'-_Distance to nearest lot p g Number of its...../--------------Lining mate riai—e4z.�o6.....Size: Dia meter-_X2 ----------Depth_.2___3_'_____--._-_.___._.. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.__._. ........................... ❑ Size: Diameter_ .---Depth------------- ---------- - - - - - - --..Liquid Capacity. ..................•-------gals. TOM Privy: Distance from nearest well...-------------------------------..-----------Distance from nearest building_._.__._____.._,_____,.____._._._----- ❑ Distance to nearest lot line--------- --- - - --- -- ------- - ----------------------- ------------------------------------------ ------------- ------------- I Remodeling and/or repairing (describe)--------- - ------- _4 e'----- ----------- -----------------------r----------------------------- AD --------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------- ...... '1 r� a - ------ - ---- - ---- - ---------- -- ---------------------------------------------------------------------------------------------------------------------------- - ---------------------- 1 ------------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) z f�L�'1------------ -------------------- --------- - 9 ) f' ?�--- ------ --------------- ------ ---- - ----( or Contractor) = ----------------------------- --------------------- Title / >L { (Plot plan, showing size of lot, location of system in relay n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- --- -/,- DATE S 't REVIEWEDBY---- - ------------------------------ -------------- -------...------ - ---------------------------------------- DATE---------------- ------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------ --------------------------- -- . .............. DATE--- ----- ------- -- -- -- ---- Alterations and/or recommend io s: - - ----- ---- -------------------------------------------- ---------------------------------------------- ----- ------------r-. - s -------- - '= - ---------------------------------------------------------------- --------------------------- �-- '.- - ----------------------------- ---------------------------------------- r - _ �f-------"� ------° fi = --- --- - --- -------------------------- � y `�' -- -- ------ ---- ------------- ------ ---------------------------------------------------------------------- ---:__.------------------ - . . r FINAL INSPECTION - Date_.... ..:...: 'r` SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISES B-S9 3M 3-'63 F.P.CO.