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FOR OFFICE USE: ` ------------------- ------------------------------------ // ------ ------------ ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .1.3 ... ------------------------1-. --- - ------------ (Com lete 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/��i�s...made.in..com liance.with County Ordinance No. 549. / - +Q , ' ['31 &.. . JOB AQRRESS AN C ONf- P -o�.--�------------------------M----_Sa-ce.�J 4 4 Owner's Name r _ _:"_. �. Pho - --- •---------------------------------- ----------- -- -------------- ----------------------------- --- -------- Address-----....jl__ - ----- •- ---- --1--�---------- ------------- --------- Contractor's ------- F e ]r -------------------------------- Contractor's Name------f�_._ 4r�--- -- 4 -------- one----------------------------------- r Installation will serve: Residence Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedroom___ Number of baths --/-- Lot size _____________ _________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2ro"C"lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- -,------- ) No ❑ New Construction: 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.) 3 " Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------- El __.._________________.__.._---------------❑ No, of compartments--------------------------Size-.-_----------------------------Liquid depth--------------------------Capacity----------------------- 1 I Dispos Field: Distance from nearest well----! .f 'Distance from foundation _...��-1..._.--Distance to nearest lot Iine.,Jr_.--______ _ Number of lines----------- '`Length Iof. each line,___._ O..f-------_----_Width of trench...�A-------------------_.____.__ Type of filter material_____ • �x Depthof "filte'r material f - --- -__Total length _ ._ �_----------------------------- Seep it: Distance to nearest well----160 f Drstance from_foundation �---------.Distance fo nearest lot line_.. _..._-7- Number of pits-------- ------------Lining __.Size. Diameter--------44 �� Depth_ .v?. ------------------- Cesspool: _`_ __.___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------._._________.________._______ Size: Diameter_------------------------------------De th---------.------------------ -------------------:--_Li quid Capacity __gals. Privy: Distance from nearest well----------------------------------.--------------Distance from nearest building______________.______.__-_-_________..._. ❑ Distance to nearest lot line- - - ------------------------------------------•------------------------------------------------------------------------------------------- , Remodeling and/or repairing {describe):------- _ __ n I ---------------------------•--=•---------------------------------------------- - ------------ - ---------------------------------------------------------------------------------- - ---------------------------------------------------------- -- --- ---------------------------- ---- ----------- ------- ------------------------------------------------------------------- --------------------------I------------------------------------------- -- I hereby certify'thaff have prepared this application and'fhat•the work will be done in accordance with San Joaquin County ordinances, Stateallawnda rule_s and regulations of the Sa Joaquin Local Health District. (Signed)--------------- ---------------- -- i jay F ti, --- ----'fir and/or Contractor( ----------- ._e.- _ ` ; _ Title_______ Plot Ian, showing size of lot, location of s em,m �e tion to wells, buildm s, etc., can(be ) B _ ( p g y g placed'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY� -- ------------ ------------------------------------------- DATE_/ ---------------------------- REVIEWED BY--------------------------------------------- -------------------- --------------------------------------------- DATE---------------------------------------- ------------------- BUILDING PERMIT ISSUED--- /----- - ----._ DATE-------------------------------- -------------------------- Alterations and/or recommendations:._._-__ }. . ---------------------------------- --------------------------------- -- - ---------------------------------------------------------------------------------------------------------------------------------- r --------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------- ----------------- -------------------------- ---------------- ----------------- -------------------- -------------------------------------- -------•--•---- - FINAL INSPECTION BY: _ r - Date.f -6 .��.--•---------- ----------------------------- 3 , N SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cq.