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FOR OFFICE USE: --------------- - - --------- - ---- ------------- --------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ._.lJ�/.s..... (Complete in Duplicate) ----------- -- ---- ------ Date Issued --- Z Oy— ________________________________ This Permit Expires 1 Year From 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 w .ih County Ordinance No. 549. 4� JOB ADDRESS AN OCATION--- - ---- - ------------------ --------0 ------- i --'�� Owner's Name =. - Phone------------------------ --------•- --- ------ ----- Address - --- -------------------------------------- Contractor'sName----- ----- --------------------------------------- ------------------------------------ ---------- Phone---------------------------------- Installation will serve: "Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms --.Number of baths _./_ Lot size __-___ ____ ______________________________ - Water Supply: Public system ❑ Community system ❑ . Private X Depth to Water Table ---40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ;Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date____________________) No` ,r New Construction: Ye No ❑ FHA/VA: Yes ❑ No TYPE.OF INSTALLATION„AND-SPECIFICATIONS:-,-. (No septic +ank or cesspool permitted if public sewer,is available within 200 ferret.) - - Sep i Tank: Distance from nearest well_._�0.�°Dist n e f o f und�ion___f- _ Materia _ �- No.tof compartments _ �'�'". ------- ---------- p I--------------Size _ _ _ :-..Liquids depth---------- ---- ,---.Capacity------Zp--a_-- Disposal Field: Distance from nea t well-x_ro'O_'+Distance from foundafion.._:�,�-----Distance to nearest lot ipp____.�t' Number of lines__ - ____________ __ Length of each line ---,,--".Width of +rench___�--�.__________-_______ ------ .. Type of filter material_�_� t»Depth of filter material------�__i�-___-.-.Total length------J_'_4r__p___________ ------------ Seepage Pit: Distance to nearest well--------------- ______Distance from foundation_________ __ ___ Distance to nearest lot line----- _________ ! ❑ Number of pits----------------------Lining material--------------------.,_Size: Diameter------------------.----Depth------------------------------ j Cesspool. Distance from nearest well-----------------Distance from”foundation._________,_._,____;Lining material _____--...._..____.______:_______- ❑ Size: Diameter-----r- -----------------------------Depth- -------------------------------------------------Liquid Capacity----------------------------gals. S �r Prixy.:,jz, _Distance rom_nearest well______________=:__-________=- ._____ D.istancaTfr-om,nearest�6uilding:__=---------------- I Ago ❑ Distance to nearest lot line---------------- '` � Remodeling and r e.p ring {describe : x =-------------•••--- --•------------------••-•-- II ll''�� 4. --------------------------------------------------------______________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regula+ions of the San Joaquin Local Health District. (Signed} ----------- ------------------------------------------ -- - - ---------- and/or Contractor) - -- - - ------ BY= -- •--- ---- ---------------------------------- {Ti+le)---- -----------------=------ - . (Plot plan, showing size of lot, location of system.in. relation-Jo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ----=- -- ----- ---------------------------------------- : DATE--- --- -------------- REVIEWED BY---------------------------------- - ------- DATE----- �' BUILDING PERMIT ISSUED---- •-------------------------------------------------------------------/1� --------- DAA'E------------------------------ Alteratio sand/or recommendations:_______ t__ -_-_ _ ._ ________________ -------------------- _ -�.--_-- x� --------- J = ---------- ar�-------- -- ------- ----------- ----- ___________________t_`-_-.--.__.___-..-_--__.....____-._____..________._.__-._.__.____.._._.__________.____._.___.__.-__-_____---_--._.----__.______---____________________________________.------------------------------ ------------------- __------_______.__-_______ .____. ____ - ______________-------------_----_--------------_------_------.--------------------------.--------------_._-._---___._________ / J / I FINAL INSPECTION BY:---- _ Date----------------/-_ ~j 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 EB 9 REVISED 8-59 3M 3-'63 F.P.00.