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FOR OFFICE USE: �;_ --.I ------------------------------------------------------ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...... �`�� (Complete in Duplicate) �. - Date Issued -rc 6> Application is harsh made +o the San JoaquinLocalHealth Dit Expires I strict From Darts Issued } pp y q permit to construct-and install the work herein escribed. This application is made in compliance with County Ordinance No. 549. -------- OB ADDRESS"AND CATIONA =- --------------------------------------- Owner's Name-------•- _-__-- . 1 Phone ------------------------- Address....... ----•----- -�---• . l = d :_ Contractor's Name--------------------- --------------------------I-----------•---------- ------ ------ -- --•-------------------------•--- Phohe----------------------------------- Installation will serve: Residence's Apartment House ❑ ,,Co/mmercial E] Trailer Court E] Motel ❑ Other ❑�� Number of living units: -------- Number of bedrooms ----2- umber of baths ---/--- Lot size ______/__r "__.t.............. Water Supply: Public,system ❑ Community system ❑ Private �y Depth to Water Table _J- ft. Character of soil to a depth of 3 feet:'*Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay K Adobe F] Hardpan E]Previous Application Made: (if yes,date---------------------) Noy New Construct�Ys, o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Di tan nearest well---- Distance from oxundation___. _ -_.Mat rialff.._�`tc � ________________ ________ �, o co artments_____'7 ___:_._ .__Size_____ _ _- !]_._ rLiquid depth______ ._re _.Capacity_..___ �.:�____ Disposal Field: Distance from nearest well_J;_� __�._Distance from foundation.-.. ..a�-_.Distance to nearest lot line--- v s .._Number of lines-------- --------_ engfh of each line_--_-IQ-�____ ___ .Width of trench------ '" r.- J f Type of filter material___ __1__ ___._ . pth of filter material_ _.,_-___,____._Total length-__.______�_ ��_______________._ Seepage Pit: Distance to nearest well----------------------Distance from fourstze: do`n _,______' 9K-,3d nearest lot line______..________� ❑ Number of pits----------------------Lining material---------------------- Diameter-------------------- -Depth----------------------------_----;I Cesspool: Distance from nearest well-----------------Distance from foundation.-------------_.__.Lining material-------------------------------------- ❑- Size: Diameter. Depth Liquid Capacity----------------- ---- gals. _____ - Priv Distance.from.nearest well -- ------------------------------Distance from nearest buildin ❑ Distance to nearest lot line--------------------------------- ----------------------------------- -= *. Remodelingnd/or're iirring (describe � _"e _ a- 07 I -Y W_-------h -+rl `-- --------------------------------------------------------------- 4es, S+afe -- ---- - ----------------------------------•- •----------------------------------------------------------------------- 4------------------- ---- --------------------------------------------- I htify th t I have prepared this application and that the work will be donel in accordance with San Joaquin County , "ordinan la and rules an regulations of the San Joaquin Local Health District. [Signed �-� ---------- ---- - (Owner and/or Contractor) ------------- -------------------------- BY --; ---------------- -----(Title)------------------------ --- ----------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------- ----------------- --- ---- ----- ------------------- DATE.----- ------------------- -------------- REVIEWED BY-------------------------------------------------- ---------------------------------- -- DATE------ - -- BUILDING PERMIT ISSUED--'- DATE. Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -------------------•--------- ---- •---•---------._..-. ------------------------------------------------------------ FINAL INSPECTION BY:........ --_ .__-- _-(--- ?"-. _ - - - �'=� - --- -- Date--------------�------ --------------- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. ° 300 West Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVk5E0 B-59 3M 3-'63 F.P.CC.