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F OFFICE USE- --------------- SE: ------------- �f- APPLICATION FOR SANITATION PERMIT Permit No. .....1..(�. ...� --------------- -- (Complete in Duplicate) 9�Z /it Date Issued ____________........... 3 _-------------"�'�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 AND LO ATION---. •-••---•-••-. ------------------------------------------------------------------------------------- --------------------- �� Phone__ =.'�3�g G Owner's Name-----�•-•--•• ---- -•------------------1►- ------------------------------------------------------------------------------------------- --•-- •-. .---, ------------------•------------------------------------------------•-•----------•- -------------•----------•---•------------- Contractor's Name_.._Ca�.�`�"---•-S--�S----•-------------------------- ------------------------------------------------- Phone Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ o x� Number of living units: ----I--- Number of bedrooms -_e?-. Number of baths __1__-- Lot size ...---�q------d---2-0----------------------------------------- Water Supply: Public system e'' Community system ❑ Private ❑ Depth to Water Table A6_ 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 nk: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments--------------_---------Size--------------------------------Liquid depth--------------------------Capacity------------- ---•--- Disp , �/ Distance from nearest well_____.___-_Distance from foundation---1.........____.Distance to nearest lot line................. _.____Length of each line....... ` Gt ) Number of linesp Width of trench Type of filter material .../ 0.��-___-___Depth of filter material----M7-------------Total length____3`_'_`_________________ Seepag -Pit: Distance to nearest well-------------------Distance from foundation---to...........Distance to nearest lot line--`'fl--_---- Number of pits_-I---------- -------Lining mate rial'__&G_�C.-------Size: Diameter__�3--------------Depth....23__.................... 0 Cesspool: Distance from nearest well_________________Distance from foundation____-_-___-----___.Lining material--_--_-_--_-____--_-____-_--•-.---__- � ❑ Size: Diameter----------------- _-------_---Depth----------------------------------------------------Liquid. Capacity-----------•-••-----------gals. .Y Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_-_-----_-____._--_-___----____-.-_.-._. ❑ Distance to nearest lot line----------------------------------- ------------•--•---------------•--------------• ---•-----•----------------------••-----------•--- Q Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------•--•-------•-•••---•--••••---••-•----•----••-------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the an aquin Local Health District. (Signed) �4re ---- - -- ------ -------------------------------------------------------(Owner and/or Contractor) By:---------------------------------------------------------- ---------------------_ ----------------------------(Title)---------------------------------------------- ------- --------- (Plot plan, showing size of lot, location of system ition to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY __._.�. -- - ---T----- � APPLICATION ACCEPTED BY----- ` --------- - ----��v~---- ---------------------------------------- DATE------- ----------- ------------------------ REVIEWEDBY-------------------------------------------- -------- DATE------------------.----------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------......------------------------------------- DATE------ ...-_-------------------f--------— Alterations and/or recommendations:._.__„1 t-"=?:' %`�t �� p=�--Vis--,, '-`= V---_`-'--- ----- �`�--- ----- .. f•-•-•-••... �r ------= ------ •-• -•-•------••......--•--- --------- - . -. r. .r -.--_-. \ /'� ' -Zr�---'e--.--------?._s+ --�®--C-s--- - - --'�--- •4-•L �-� -�. -lam•_-•• ----- �z A. ------------•-•--• ---------------- -------•-•------- ------------------•---------------------•---------------------------------------•--------•-••-••-----•---------- .......................... ------------------------------------------------------------- i- -------- -- G LZ c s-1 Date----------� ` �s FINALINSPECTION BY--------------�-a---�------------------------------ ------------------------ 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-S9 3M 3-'63 F.P.CD.