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FOR OFFICE USE- ------------------- - SE:------------------- -u -�• r -------- "----- .A---------- APPLICATION FOR SANITATION PERMIT Permit No. ... �.- --- ---- -------- -- ------------- . :(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 08AZ , ance No. 549. VF Ozez� l JOB ADDRESS AND LOC T10N i0 --- ------------------------------------------- ----------------------- E.e �" 0-..------- � Z --------�� Phone 4a - �: -y7a3 Owner s Name ----•---- Address---------------------- rn....��! r- -------------•------------------------------ ---•-- ---------- ---------------------------- ----- ---------------- Contractor's Name-.-------___7i� --- l!K-------- --- - - —c.S�:4 x----- '}hone ----- Installation will serve: Residence JX Apartment House ❑ Commercial ❑ Trailer,,Court ❑ M'otel ❑ Other r Number of living units: .- ___ Number of bedrooms ._!-_ r -- � � /QCT .� `1 - 1 __ Number of baths _ _ Lot`size --------------------------------------------------- Water _�________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay❑ Adobe,k' Hardpan ❑ Previous Application Made: (If yes,date_____________________a No ElNew Construction: Yes ElNo"Mir FHA-/VA: Yes ❑ Na, TYPE OF INSTALLATION AND SPECIFICATIONS: ,• if E e (No septic tank or cesspool permitted'if"public se Distance siav-466[lefounda o4_fe.t ._._ Materia 4��. Septic Tank: Distance from nearest well-.'�'.____. p 1I-__14 ------- a-------~--Liquid depth--------------L Capacity----- ❑ No. of compartments-------- -----------"-"--Size--�-�-- � �--- Disposal Field: Distance from nearest well..'--__._.._.Distance from {foundation-,____l�C_.____Distancle to'nearest lot line----- -------- - ____ � Number of lines________----�-- Length of each line,__-___��. -�i__"_.Width of trench___________ t+l�'_._ Type of filter material--s _ Dzipth of-.-filter.material____.____1?__._.___Total length---------- 1_------------------ __(ss.... „J Seepage Pit: arnrest well. Distance from found _Distance to nearest lot line__.__"_______.. ❑ Number of Pts -- Lining matria _ Size: Diameter ----- Depth--------------------------------- hQ . 1 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material__-_._._-.__________.__ '------ ❑ Size: Diameter Depth----- ----------------------=-----------------:__Liquid Capacity--------------------------.gals. 7 Privy: Distance from nearest_well_--_"_ _____—........ :. .. ......D.istance from,nearest_building__-__-_.______--__-______--_________- �y. _ ❑ Distance to nearest lot line------------------------------- �T" ' Remode ng d/or epairing (descri e):____ _ g------ ----- p -------------- I ---------------------------------------------------------------------------------- ----------------------------------•------------- -----------Ii-----::J-----------.----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. ✓ ---------- _` (owner and/or Contractor) (Signed)----------------- By:------- ------- - ----- - ---=------------------------- - --- -- ----------------------------------- (Title) ---------R----------------- ..... - -------------- (Piot plan, showing size of lot, location of-system-in,relation fo_wells,-buildings, etc., can be placed oon reverse side). . r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - � /kf..--- '+ rDATE- f REVIEWED BY - r BUILDING PERMIT ISSUED-------------------- ------------------------ -------------------------- DATE.. = - Alterations and/or recommendations:__________________________ i -------=-------- -------- --------------------- --------- -------------- ----- -------------------..__..... - - -- -------------------- ------------ -- ---------------------------- ----------------------- ------------------------------------------------------------- �t ✓�C� w _ / 3 i 3-------------------------- ---------------- Date ------ FINAL INSPE=CTION BY:_"__...._.'d___._._._ _.._"_"""___. � s 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 9.59 3M 3-'63 F.P.CO. =�