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FOR OFFICE USE: /----------------------------_.----_________----.- APPLICATION FOR SANITATION PERMIT Permit No. ___..._ __.._^� Z (Complete in Duplicate) = -: ---w---- This. Permit Expires 1 Year From Date. Issued Date issued Application is hereby made to the San Joaquin Local Healfh 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---> �r� i- Owner's Name 11 Q + Ct &.4 ._a Phone Address_____________1}� O• �`- I �. - Contractor's Name----' ``` --------------------------------------------------------- ---------------------------------------------- Phone----------------------------------- Installation will serve: I Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms __ __ Number of baths -1----- Lot size ------------------------------- Water __________________________ _Water Supply: Public system ❑ Community system;] Private ❑ Depth to Water Table 70__ ft. i Character of sail to a depth of 3 feet:' Sand ❑S:.Gravel ❑ - Sandy Loam Up Clay Loam p Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No [V New Construction: Yes © No ❑ FHA/VA: Yes ❑ No ❑ fi TYPE OF INSTALLATION AND SPECIFICATIONS: V1 (No septic tank"or cesspool permitted if public sewer is available within 200 feet.) eptjc nk: Distance from nearest well_________________Distance from'foundation------_____________-Material-___._.________-_---_--__.._______----________- No. of compartments--------------------------Size-----•---------------------- ---Liquid depth---------------- --------Capacity-------------------- f Disposal Field: Distance from nearest-wells _.OVIY _bistance ,frorri dation:___)-°:_'"__.Distance to nearest lot line___ -_____ Number of lines_____________ _----------------- Length of each line-----s� a ---------------Width of trench---�-�-----•------------------ t �.� Type of,filter.-material + ,_ epth of filter material____./L_�___-------;Total length__�e'_______________________________ !! z Seepage Pit: Distance to nearest well----------------------Distancetfrom foundation--------------------Distance to nearest lot line-------,--------- Q ElNumber of pits---------------- -----Lining material-----------------------Size: Diameter_----------------------.Depth--------------------------------- f F Cesspool- Distance from nearest well_______________4Distance from foundation--------------------Lining material__._____-----------.--_--________-__. ❑ Size: Diameter--------=------------r----------------Depth---------------.---------------.- -------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building____-----_-__________.______-__-__..___. ❑ Distance to nearest lot line---------------i--------------------------------- r -_ 9► Remodeling and/or repairing (describe)------------------ ----------------.- --- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•-------------------------- ---------------------------------------------------- -----------------------=-------------------------- ------------------ ---------------------------------------------------------------- ----------------------------------------------------- ------------- -------------- I hereby certify that I have this application and that the work will be done in accordance with San Joaquin County ordinances, St d es nd regu ions of the San Joaquin Local Health District. r (Signed). ----------------------------- ---------------------------------------------------------------- ------(Owner and/or Contractor) By------------------------------------- -------•--=------------------------------------------ --------------------------------------(Title)----------- -------------- (Plot plan, showing size of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY----- -- -- -- ---------------- REVIEWEDBY ------------- --------------------------------'-------------------------------------------------------- DATE------------ BUILDING PERMIT ISSUED-----------------------------------------------•--------• ------------------------------------------- DATE--------------- Alterations and/or recommendations---------------------- ------------- - ------- --------------------------•------------------------•---•---- -------•-•------••------------•------------------------------------------------------------- -----------------------------------------------------------------------• ---------------------------------------•------------- ------------------------------------•--- ------------ FINAL INSPECTION BY:- - ------------- Date `-J7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 3M 3-'63 F,RCa.