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�OR OFF4CE �1SE: -`-- ---- -------- APPLICATION FOR SANITATION PERMIT Permit No. ....................... ------- (Complete in Duplicate) 3 f/ - .___ 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. JOBADDRESS AN TION----- �- ------------------- ----------- - --� �_�1___�..- ---------------------------------_•.----_.._----.__...-------- Owner's Name-------------- -- -----•-----• Lf Phone Address ---------------- -�z_ �� s Contractor's Name----- ------------ Cl 'Cj ------ Phone Installation will serve: Residence [J partment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ Number of living units: -,/___ Number of bedrooms ____Number of bath______ Lot size ___. 'r^- -------•---------------- Water Supply: Public System 9?--Community system ❑ Private ❑ Depth to Water Tablel_15-,7t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpant Previous Application Made: (If yes,date____________________) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 2_" � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well._.,,r ___ Distance from-founclafion_10.__...__.Ma wi�__ -_.0 --: ---- _-________- *Z � . Liquid de th___.-' - g.-----Ca acty- ----- ______.:__.No. of compartments.-sr Disposal F• Distance from nearest well! _._Distance from foUndatio lJ.�.._.Distance to nearest lot lineaSY________ [ Number of lines•_..____ _____ /------------Width of trent moi, l-- ,�Length of each line Q , Type of filter material___ _Y ,CUepth of filter material__ _ ____Total length___..,�Q__..............-............. See pag it: Distance to nearest well._ /"=__Distance from foundation__%Q.�__-_. istaf5e to nearest (o# line/___ _ Number of pits. .. Lining matenaL-_�_�•� 6''-Size: iameter________----- -------Depth,=-;)07___________________ Cesspool: Distance from nearest well_ ________Distance from foundation___________________Lining material------------------------------------ El Size: Diameter-------------------------°'' Depth-- -------------------------------------------------Liquid Capacity- ----------------••------gals. Privy: Distance from nearest-well--------- _. ------------ --------- from nearest building------------_................_______._. ❑ Distance to nearest lot line---------- ------------------------ -----=-----------=----- ------------------------------------------------___--------------------- Remodeling and/or repairing (describe):-------------- ---- ----- -' - - -_ �--- --- �ar,'-`-------------- --------------------------------------------------------------------------------------------------------------'-------------------------------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby fe I have preps this application and that the work will be done in accordance with San Joaquin County ordinances, Sd ules an regnsof the San Joaquin Local Health District. (Signed) -- --1--- ------ -------------------------------------------------------- (Owner and/or Con actor) By:-----• -------•-••--- �1 (Title) ---------- - ..... - - - (Plot plan, showing size of lot tion of system in relation to wells, ui ings, etc., can be placed on reverse side). �r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ Y-------------------------------------------------------__ DATE----------- `2—� -------------------------------------- REVIEWEDBY------------------------------------------------------------------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommensjI I ns________________________________________ �C�//- - ----• - o�-------------�-------------------------------- -------------------•-- -----•-•--------•--------__------••-•.-•------- �---�2 �6.3 R ' -- •- �J ---------------------------- ----------------- -------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- ------•--------•-•------ -------------------------------- --------------- ----------------------------- ----------------- ----------------------------------- •............... FINAL INSPECTION BY:------C 474- Date------- ------------- '' 2 ------------- ----- SAN JOAQUIN 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 ES 9 REVISED 5-59 3M 3-'63 F.P.CD.