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FOR OFFICE USE: __ — --------- - j �� 7........... ------------------------------ ---------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. - -------------------- (Complete in Duplicate) �4--- -------- ---- -- —---------- This Permit Expires I Year From Date Issued 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 D LOCATIO . . . .............. . ........ .... ------------------------------------------------ Owner's ------------ Name -------- ----------------------- ------- -------- Phone Address--------------- ------------ ---------------------------- ----------------------------------------------------------------------- Contractor's Name-_ 1 .Arf�1�111.N__/L__ ), _ .. ------------------------------------------------------------------------------ Phone.............--------------------- Installation will serve: Residence jW Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other [3 3 Lot size ___cam/--- --- --------------------- Number of living units: _/----- Number of bedrooms _c �__ Number of bathst/ Water Supply: Public system ❑ Community system El Private 9 Depth to Water Table Z.0- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 11 Clay Loam El Clay El Adobe Hardpan ❑ --------------------) No El New Construction: Yes No El FHA/VA: Yes [:1 No El- Previous Application Made: (if yes,date TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -- Septic ---Si Tank: Distance from nearest well__��._ Distance from foundation_/--C - ____.Mate lalVlt--' - --- ----- ize_�---V'1.2 No. of compartments---��R ----- - ...Liquid depth___ ----------Capacity/,We% Disposal-PQW-- Distance from nearest j I " X/--------- ------- -Distance from foundation.,.2Z----------Distance to nearest lot line,��.2_, Number of lines -__Length of each Iine_�/S___"/ Width of french------ Type of filter material.�_I� --Depth of filter material----------- length___ _�_� �_� �;, Seepage ength----- Seepage Pit: Distance to nearest well ______._____".___.____Distance Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-------------------.Size: Diameter---------------------Depth--------------------------------- Cesspool: Distance from nearest well V 0 Size: Diameter------------------------- -Distance from foundation--------------------Lining material___-._________________"____-_________ P -_Depth----------------------------------------------------Liquid Capacity- ------------------- ------gals. Privy: Distance from nearest well---.-.- -----_----------_------------Distance from nearest building----------------------------------------- 0 Distance to nearest lot line_____..______.____________________"_..__ --------------------------------;--------------- ---------------------------------------I-------- Remodeling and/or repairing (describe):---L_lk ---------- !L-_---_----------- -------------- ------ ------------------ -----------------------IL------------------------------;,--r---------- ------- -------------------------------- ------------------ -----------7� ----------------/I-------------- ---- - ------- ---------- ------------ --------------------------------------------- - ------------------------ --------- --- ------------------------------------- ---------- ---------------- ----- - ----------- -------* ---------------------------------------------------------- I hereby certify f f I have prepared this application *hd that the work will be done in accordance with San Joaquin County ordinances, SW4 laws, and,,rules and regulations of the Sin Joaquin Local Health District. (Signed)------ ------ ------------------------------------------------------------------------------------- -- ----- Itw---(Owner an-d-/-or ContractorBy:------------ ) .. ..----------------------- --- - -- - ----- -- (Plot plan, showing size of lot, location of system idefafion to wells, buildings, etc., can be placed on reverse side). RL7R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------- ------------------------------------------------------- DATE____BY ----- ------------------- -------------- -------------- -----------------------------------------------------------------------------------_-- DATE--------- BUILDING PERMIT ISSUED Alterationsand/or recommendations:__._______._________.____._-___.._____-_-__-__-------------------------------------------------------------------------------------------------------------------------------------------------------------------_------------------ ----------------------------------------------------- ------------------------------------------- ----------------I----------------------------------------------------------------------------------------------------------- -------------------- -------------- -------------- ------------------ ------------- ------ -------------------------------------------------- ------------------------------------------------------------------------ --------------------------- -----------------------------------------------------------------------__ ----------------"--------------- ---------- FINAL INSPECTION BY:------/_ ---------------"---- Date-------------- --- _---_---_- SAN -----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.Co.