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FOR OFFICE USE: ------------------------------------------------------ _- ---- -------- -------- APPLICATION FOR SANITATION PERMIT Permit No. _�_2..J__3.o (Complete in Duplicate) ------ --------------------- I This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to th an OJ�oaquinocal Health District for a permit to construct and install the work herein described. This applicati �m�/J�n com n e ce No. 549. / � o�C JOB ADTSS AND OCATION_--�_-- --- -- - ---- ,� �� Owners Name 1� '1 --------------- Phone /� -•--------------- Address-- --------------------------------------------------------------------------------------------- Contractor's Name ----- Phone................................... y Installation will serve: Residence [�Apfartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms .tZw,_ Number of baths Lot size ;✓_"-------------"--____--_-__ Water Supply: Public system ❑ Community system ❑ Private R� 6epth to Water Table///_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M/Clay ❑ Adoba- hardpan ❑ Previous Application Made: (If yes,date-------------_-----) No ®/'New Construction: Yes ❑ No ®-'FHA/VA: Yes ❑ No Z�, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is vailable within 200 feet.) Septic Tank: Distance from nearest wellistance from foundation________.______. ------------ Mat No. of compartments_-___.'-_-_--____--___Size..�` __XLf_,___Liquid depth_ -------------Capacity_,1F� '2---_- Disposal Fi d: Distance from nearest well_��. . Distance from foundation _*2Z'9_" to nearest lot line_______ _______ 09 Number of lines_______. _. Length of each line_ G`9'______ ___---Width of trench-A'_�_ __ __.____ 6 x Type of filter material_ "Depth of filter materiaI__Z,�_�____-Total length_ ''--" '(f____-" [� Seepage Pit: Distance to nearest well-------------.--------Distance from foundation--------------------Distance to nearest.iot line----------------- El Number of pits---------------------Lining material----------------------Size: Diameter----------------------Depth-:- ------------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining 165 material❑ __--.__.-__--___-___-_-"-__._._______Size: Diameter A -------------- p ----------------------------------------------------Liquid Capacity----------------------------gals. r Privy: Distance from nearest well------__-----------------------------------------Distance from nearest building-_-_____ Distance to nearest lot line__-_--___.___.____..____.__._. Remodeling and/or repairing (describe):-._-_. � ----- ------------------ . c� .�_a/C--- ------------------------------------------------- ----------------------------------------------------------------------------------- ---------------- -------------------------------------------------------------------/------------------------------------------------------------------------------------------------------------------------ --- I 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, an rules and re ulatins of the San Joaquin Local Health District. (Signed) �-/,{� --- - -- ------------------------------------------------------{ or Contractor) By:------------- / j (Title)--- --------------- -- ------- - - -- -------------------------------- (Plot plan, showing size of lot, location of systefn ' relation to wells, buildings, etc., can be placed on rever a side). FOR RT ENT USE ONLY APPLICATION ACCEPTED BY---------------- DATE --------------------- --------------•- EVIEWED BY --------- -------- ----- DATE ------ ---- ---------- ------ --------------------------------------- UILDING PERMIT ISSUED — ----- DATE ------ ------------------------- Alterations and/or recommendations:-------- -------------- ------------ ---"-------•-------------------------------•-----=------•-----•-------------------------•----- ---------------------------------------------------------•-----------•------------------------------------------------------ ----------------"------------------------- ----------------------•-------- ------ --------- --------------------------- ------ ---- ----- -- ----- - --- -------------------------------------(-------------------- FINAL INSPECTION BY------ --------- _- ` GZ ---------- -- ----/- - - 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 a-59 3M 3-'63 F.P.DD.