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F F R OFFICE USE: _�_-_-__-_ - 1 ---- APPLICATION FOR SANITATION PERMIT Permit No.-------------- .. -�,� -'..� f � � �CJom e� n Duplicate) ' Da+e Issued-.- _-- This Permit Ex ires 1'lYear 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 LOCATION__.- -- � l --------- Owner's Name------ ' te J r ... -- - - - ----- ._-� �- --------- Phone Address---------------- : ---------------- --------------------------------------------------------------•---- ------------._...------------------ ........ .... Contractor's Name---- ------•---•-----•------- -------- Phone------------------------- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel [-] Other ❑ Number of living units: __/___ Number of bedrooms)--__"Number of baths �___ Lot size ��__ Water Supply: Public'system,- Commuriity„ system ❑ f Private ❑ R Depth to Water Table -------- ft. Character of soil'to a depth of. 3 feet: ' Sand ❑ Gravel ❑ �-NewConstru'cf oam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous A Iication Made: if es,date___-____, -_l'� PPy� I Y No ion: 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 Tank: Distance from nearest well_________________Distance from foundation--------------------Material ______________'_._______. ❑ � No.,of,compartments------ -----------------Size---fix----- -------------Liquid depth---- --------------------Capacity----------------------- Disposal __ Field: Distance from nearest well--------------_-Distance frdmr foundation--------------------Distance to nearest lot line----------------- Nu mber of lines------R--------------------------- Length of each line---------- -------------- Width of trench_----- ----------------- - ----- Type of-filter material_______________-----.--_Depth.of filte_r.,material-___-__-.---______-__Total length---.-_-_-______.:____ 411 e�; It Seepage Pit: Distance to nearest well____________________ _ Distance from foundation__N.__._______.___.Dista�a to nearest lot line__`____.__ .. Number of pits__-______`------___Lining material----rk_4?'-_Size: Diameter__ ~ - Depth_._ --------_ foundation--__IfI-------Lining material_-- --_ r ❑ Size: Diameter---------------------- --------- -De th---------"" - --------- Cesspool: _ Distance from nearest well--/- ---Distance from - Li ui.d Ca Capacity P --- q p Y----------------------------gals. Privy: Distance from nea-97sf well______--_______ _ --____. -- Distance from nearest building -------- ------------ ---------- Distance to nearest lot line___________f__ ___•___+ ________________ }-. ------------------------------------ Remodeling and/or repairing (clescribe):____I-..........I - � --- . ---- ----- � - - . > r-- - - ------ 2 ---- - '` ' ---- --- ------------------------------== ----•----------------------------------------------------------------------------------------------------------------------------------------------. I hereby certify thatl 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 San Joaquin Local Health District. syr - ; �,- --------------- ----------------- Vii`------------------------------------.4---- ------ ..(Owner and/or Contractor) By:---------:-----_- r a ------------ ---------------(Title)---------------------------- ----------- - (Plot plan, showing size of lot, location of system in relation to wells, byildings, etc., can be placed on-reverse side). FOR DEPARTMENT USE ONLY � 'BY 'v"--l----. -- ------------_------------------------ DATE ]`/z Z -APPLICATION ACCE • REVIEWED - BY ------- ---- --------- -------- DATE r BUILDING PERMIT ISSUED---- -' -----------------------------------�--------- DATE---;------------------ -- - Alterations and/or recommendations:____-. ------------ `' — ` .�?---------- ------------------------------= --------------- ----------------------------------------------------------------------------------•----------------------------------------------------------------•-- ------------------------------------ ------- ----------•---------•-------- ----------------- --------- ----------- ------------ ----------------------------------------------------- ---.----------------- ------ ------ FINAL INSPECTION BY:__ _. -.---- ¢-------------------- 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 6-S9 3M 3-'63 F.P.CC..