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FOR OFFICE USE: --------------------- ----------------------------------- APPLICATION FOR _ SANITATION PERMIT." Permit No. ..�.Gy_�.._ ------------- - --- ( - _ �--1-_.--- -----------______._ (Complete in Duplicate) -------------- -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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 A LOCATI � ... ¢ ------------- /// -- [ A Owner's Name ►�' �� n �-�_= ` r /jaw!✓ _ r_: J ---_---- Phone......__..._..1 ----- Address , -�`�-------` ........---------------��-�---------------------- 1 Contractor's Name------------�t1k-� -- ----------------------------------------------------------- - ---------------------------•-•--...------ Phone......................------------- Installation will serve: Resident Apartment House ❑a Commercial ❑ Trailer Court ❑ MotelOther ❑ Number of living units: ---L Number of bedrooms _ '_ Number of baths __1___ Lot size -_��---- -------------------------------------- Water Supply: Public system ❑ Community system ❑ Private D---Depth to Water Table .1__-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----- Nox New Construction: Yes No ❑ FHA/VA: Yes E] N0A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welh__1_.r ..__Dista a rom founon-___�.- -.Mit iaL...._ <r No. of compartments..____.fl__ __.._.__Size_. _�. ., �_..Liquid depth-___-_._�_�--_._._Capacity_ _ _ _ _.____ ----------- Disposal Field: Distance from near t well---�__�.�----Distance from foundation.___3.��.._.._. i tante to nearest lot line._ff— , Number of lines____ ___ .... ___._ __Length of each line� __'7U_' �7 =_4idth of trench---------�. ._______.._._ Type of filter matenal,l_.)__-g Depth of filter material_.__/_ _________Total length...... �:(�___________________ 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----.-._--_____--_-.___---_-----_-_-. ❑ Size: Diameter--------------------------------------Depth--------......------------------------------------- Liquid Capacity...........---..............gals. Privy: Distance from nearest well-------------------____ _ _____ ____________Distance from nearest building---------------------------------------- F1 ----- --❑ Distance to nearest lot line------ ----------------------------------- -------------------------------------------------------------------------------------------- Remodeling --- -------- -Remodelin and/or repairing describe :_ . E:xll___...ne?,Z_,_____{. ,.__..- ----•-------------------------------------------•-••--------------------------------------•------------------------------- ------------------------------------- -----------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have epared this appli t on and that the work will be done in accordance with San Joaquin County ordinances, State I Ws, and rule nd re ations the San.Joaquin Local Health District. (Signed) . -- ----------------------- - ---------------------- ------(Owner and/or Contractor) By:--------- --------------------------------------------------- -------------------------- -----------------------------------------(T'itle) - - (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 APPLICATIONACCEPTED BY-----------------------------..------------------------------------------------•- DATE �. - ---------------------------------- REVIEWED BY '------ DATE — = ( ---------------------------- BUILDINGPERMIT ISSUED.................._---------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------ --------------------•-------------------------------------------- --------------_------------ ----------------- iv ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- •---------------- ---- .------------------------------------------------------------------------------------- -------..------------------------------------------------------------------------ ---------- r F - --------------------------------------------- - FINAL INSPECTION BY:---------- ------ ----------- -------------- ------------- Date-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. 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