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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ,l1:�?` t IA - ----- (Complete in Duplicate) - Date Issued ______ � .. 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 A LOCATION. t� �� If:- ------'-------------- - �-- `-=- ---------------- 1c� ` off. '-r - Owner's NameYs: w�== ••------------••-----------. Phone Address__.... . -- 1� , Contractor's Name------- -••--- /-« ------- -----•---------------------------•-----------••------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -f--- Number of bedrooms _7.. Number"of baths 1-1. Lot size __._.___'__________________ ______________________________ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table`3-4.- 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---------------------) No ❑ New Construction: Yes ❑ 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 T k: Distance from nearest well_____^__Distance from foundation.......�_D__'__.Material____-d-ooL�.__ ______________________ No. of compartments _ _Ca pa t p _-- !� _.�C`�__X+S'___Liquid depth__--�_�------------- p ty_.�,� Disposaield: Distance from nearest well.... a_-__Distance from foundation 6 d.........Distance to nearest lot line. .___.___.. Number of,lines_..___________ ----------Length.of each liney4_=_!A6_�-_/__BQ'Width of trench . -`-_ _.-_.___.___..__._ Type of firfier material_____S - Depth of filter material_._ "______Total length_,JP.L.V9.......................... Seepage Pit: Distance to nearest`wefl______________________Distance from foundation....................Distance to nearest lot line.....:........... Z ❑ Number of pits______________________Lining material-----------------------Size: Diameter__._______-______----_.Depth--------------------------------- v+ Cesspool: Distance from nearest well Distance from foundation--------------------Lining material_____________________________________ F1 Size: Diameter--- ------- Depth ------------------------------------ -----Liquid Capacity............................gals. 1 Privy: Distance from nearest-well------_----------------------------------________-_Distance from nearest building_____-________________________.._...___._. ❑ Distance to nearest lot line----------•-----------•-------------------------------------------------------------•------------------------------ •-------- Remodeling and/or repairing (describe) ---------------------------•----...___--------------------------------------------•---------•------•-------.------------•-- -•---• __________________________________________________________________ _:._.___-__---________________________________________________________-____________________________________________________________-_____-_.___- a ----------------------------..............................................................................................................................................................................................d ----------------__________________________.................................................................__------_.............................................................___-_-______________--.__--_._._..- I hereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin County ordinances,eStateland rules and regulations of AO-San Joaquin Local Health District.Si ned �" nd or Contractor( 9 )•----• --- _ - -------•------- -•-----------•------------•---- / ) By: - (rile) (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side), r Z FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY.--- •-------•-------------------- DATE------ .....G .......................... REVIEWEDBY------------------------------------------------------------------- ---------------------------------------------------------- DATE....................................................------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------...--•-----------•--•-----•--•------------------.�,f----------------------•------- .............................................................----•--------------------------------...-----------------•-----------------•------•----••-•-------••---•-------•------------------------••---------...-------•- ------------------------------------------------------------------------------------ ------------------•---------------------------------------------------------------------------------------•--------------------•-------- FINAL INSPECTION BY:,r ----------------- Date 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 S-59 3M 3-'63 F.P.CO.