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FOR OFFICE USE: ------ ------ 1 iL APPLICATION FOR SANITATION PERMIT Permit No. . ...�'._ .� / ... --------------------------------- - - -- - ` ` (Complete in Duplicate) Date IssuedL?. ------- 1 �_.___..__ 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 AN CATI N__•�0 l/_.�... `''` `� -------------------------------------------------------------------------------••--------------------------------- Owner's Name------- F `- - - ------------------ Phone ---.u.-,.,,-- Addres `� ------------------------------- 3.......ren �� A-4 ----------- -- -- Contractor's Name. - �-----••--•--------•------------------------------------.................................... Phone................................... Installation will serve: 'Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____I__ Number of bedrooms -4-_ Number of baths _ ---- Lot size .!t-'aej_10Lq Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ...� t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EI'l-Hardpan ❑ Previous Application Made: (If yes,date--------------_-----) No E!r� New Construction: Yes [ll'—No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /�� Septic Tank: Distance from nearest well_.'. Distance from fou dation.. ..............Material_..I"� No. of compartments--- ---------------_-Size......�.�:5�= Liquid depth T.� Capacity t Disposal . Id: Distance from nearest well___ ---------Distance from foundation...lA___-__-_--.Distance to nearest lot line,.__ �. Number of lines..................................Length of each line___Q ----- lines of trench.__t 1.rr Type of filter material?rO� __.--_Depth of filter material_ -it--_--_----..Total length.....9h-------------------------- Seepage -- --------- --------- Seepage Pit: Distance to nearest well-----_--------------Distant jrom foundation_6Q....------...Distance to nearest lot line....__.. Number of pits-------A------------Lir ing materia____ _-®C-lC----Size: Diameter_3_V'.___.-----Depth__-Z_t4�____________________ Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-----------------------------------•_. ❑ Size: Diameter---- ---------------------------Depth------------------------------------ --------------Liquid Capacity...........................gals. Privy: Distance from nearest well _____________Distance from 'nearest btfcling___::_________:._ ❑ Distance to nearest lot line--- ------- ------------------------------------------------------------------------------•--------------------•----------------------- Remodelingand/or repairing (describe):-----------------------------------------.--------------••---•-------•-••-------......................................................--------------- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- --------------------------------------------------=--•-•------------------------- -------- ------------------------------------------------------------------ ---------------------- ------------------------------•-•------------------------- ------------------ •••----------------------------------------------------------- ----------------------------------------------------- I hereby certify that 1 have prepXulati lication and that the work will be done'in accordance with San Joaquin County ordinances, State laws, and rules andof the n Joaquin Local Health District. (Signed)---:-----_----------------- ----------_ ----- ...... ------------------------------------------------------------------------------(Owner and/or Contractor) By=--------------------•---------------- - ------ ------------------------------------------------------(Tri+le)-------------------------------:--------------- ----- ------ (Plo+ plan, showing size of lot, location of-sys+em in rel tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE +�,.Z--" 7= ------------------ _ -- REVIEWEDBY-------------------------------------------------------------------------------------- ------------------ ---•----•----•--• DATE............................................................ BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE--------------------------------- ---------------_--------- Alterations and/or recommendations•.......... ...........-----------------------_ 3---------- ° ........ ..�. d G<--_------------- - ------------------------------------------------------------------------=------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------ ........................--------------------- ---------------------------------- FINAL INSPECTION BY:.. . ......14_Gvd-`----------------------- -- Date------- <3� 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 8-59 3M 3-'63 F.P.00.