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FOR OFFICE USE ------------- �� :_fo APPLICATION FOR SANITATION PERMIT Permit No. ....,1. / -------------------------- ----------� ----------- ------------ - -_, ----.1---- ----------------------- (Complete in Duplicate). pp/. (a` Date Issued ____C..7- __._______ _--- _- I - - ________________ 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 CATIO/N �� -------- ----- Owner's Name.........kQ -/ - 11 Phone 7 Address---------------------_--- .._ .-.-... . Contractor's Name------ -------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence ED__-Kp_a_rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Offier ❑ Number of living units: .. ber of bedrooms ..Number of baths/------ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,_..7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San .y Loam ❑ Clay Loam ElClay E] Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No ew Construction: Yes to ❑ FHA/VA.. Yes ❑ No [-}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted, if public sewer is available within 200 feet.) r Septic T Distance from nearest well____ -.__Distance from foundation..�_____D Ma erial_ _ _.. �C.�-_-----_-. X.No. of compartments--_:�___---_.__-__Size_.S----X�� -------- depth_..._ _��____-__---_Capacity_.. .______. Disposal d: Distance from nearest well____"-_Distance from foundation_,_®__/.....Distance to nearest lot line... i� ---------- Number of lines______________/_......____a___� Length of each line__.___.,�l..Q-�-----------Width of trench_.___r�_ _____•_...._._______ Type of filter material...: %l._F= '-_Depth of filter material_,_,/_%___-,_Total length___- .:........................ See pag it: Distance to nearest well.-_' `�/ __Dlstancom foundation_._.___.P_.__�..Distance to nearest lot line................. � Number of pits--------/-----------Lining material 3�"1--___--Depth0a�_/_/?23V/---- 6 ' __G.�.....Size: Diameter3__-?_" Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ -. ❑ Size: Diameter-------------------------- -----------Depth--------------------------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------------------------------------- _. , ❑ Distance to nearest lot line----------------------------------------------------------_-_..-----•-----•----•---------------•--------•------------•--•------------•------ Remodeling and/or repairing (describe)_______________________________ ___ ___ .______.._. - -------••------ ---------- ------------------------•------•--------------------------------------------------------------------------------•---•-- ------------------------------------------------------------------------•-------------=---------------------------------------------------------------------------------------•------------------------------------- ------ O -----------------------------------------------•----------------- ----------•--------------------------------------------------_.-:-----•---_-----:------------- -------------•--------------- --------•--•-------------------- I hereby certify that I have prepared this a 'cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and, a and egu�eisnSan Joaquin Local Health District. (Signed)------------------------ = ----- -------- --------------------------- ----------------------• ------(Owner and/or Contractor) 11 By:--------------------------------------------------•- ---------- --------------------------(Title)----� _- ----- ---- ------- (Plot plan, showing size of lot, location f on to wells,`buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------- r ---------------------------------------------------------- DATE--------- J��-------------------- REVIEWEDBY--------------------------------------------- ------ DATE--------------------------------------------------------•--- BUILDING PERMIT ISSUED--- ----------------- - --------------------------- - DATE- -------------- ----- - ------ --- -- =Alterations nd/oirecommendations-_--_-.--_ --- ----- ----- ------•. . ----- ------------------------- -----�� - '------------ . - L .-----•------•--•------------- --------------------------------------- -----------------•----------•------------------------- ------------------------••------------------------ --------------••---------------------------------------•---------------•-- ---•------------ ---•--------•----- --------------- ------------------------ --------------••----------------•--------------------•--•--------•----------•----------------------------------- --------------------- FINAL INSPECTION BY:--.--------C". C '----------------------------- Date-----F' `' Y'--�a'J��------------------------------ ....---- 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 B-59 3M 3-'63 F.P.CC.