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FOROFFICE USE: _____ ______ _ __ __________________ APPLICATION FOR SANITATION PERMIT Permit No. ----- -------- ---- ------------ -- (Complete in Duplicate) Date issued _ Application is hereby made to the San Joaquin Permit Local Health Di Year From From Date Issued for a permit to construct and install the work herein describe This application is made in complianC_ w �Coun#y Ord Hance No. 549. JOB' A DRESS AD LOC9TION4;i�_ ��, ---- -- -----------------------------L--- `` / =y • Owner's Nay _ Phone l Address - l---- - r2.- d� y' ._,J . -----W-------------•- Contractor's Name Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other E]1_ Number of living units: __ ____ Number of bedrooms ____vNumber of baths __1-____ Lot size -___--- ,-1------I----- Water Supply: Public system ❑ Community system ❑ Privat�VyL'am Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel San ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: {lf yes,dote--------------------a No New Construction: Ye\] No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public wer is available within 200 feet.) Ll0 --.Mat rial------- -- ---- Septic lank: Distance from nearest well _-s ___.__Dista fro undati.on_____ _ __ No. of compartments______..-F____._...__Size��._7 _ __Liquid depth_________.-� apacity)�-4�.<:�.. Dis osal Fie#d: Distance from nearest well_. .__ _ Distance from foundation__:�_�)--------Distance to nearest lot li e. N ---umber of lines.____ 1- _ J Length of each line__ _.Width of trench.__ _. ____.____ pe of filter material- - ":— epth of filter material____._-/u�__J__-__Total length_______, ,:�C ___________________ Seepage Pit: Distance to nearest well--------------_-------Distance from foundation____._._.___....__-.Distance to nearest lot line-----.__-__--__-- ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth----------------------.---------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----------------- >1�s. Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------- g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________.__._______________-__.__-_ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------- ----- ----- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------•----------•------------------------ ------------------- --- - --- ------- •- ----------------------------------- -------------------------------•-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- `'r��---- f----- '111��" ' (Owner and/or Contractor) Byr ------•---------------------------------------------------------------------------------------------------------------------------(Title)------------------------------ - (Plot plan, showing size of lot, location.of.,system.in relation to wells, buildings, etc., can-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------- ------- - ---- ----- ------------- -------------__----------------------- DATE--- ------------------------------------------------------- REVIEWEDBY----------------------------------------------------------------------------------------------- ------ 1d�EE --- � BUILDING PERMIT ISSUED.------------------------------- ----------------------------------------------- Alterations and/or recommendations--------------------------------------- ---------------•-•----------------•----•---•-----------•----------------------------------•----- ----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------•---------- •----•-•-------------------•--------- -----------------•-------------------------------------------------------------------- ---- -------------- ------------ -------- --------------------------------------------- ------------------------------•---------------------------------------=----- ------ •------- ------ ------------- ---....------------•----------------------------------------------•---•-------- FINAL INSPECTION BY:. . ... ---- Date---------------------I '� � ------------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER H•S9 3M 3-'63 F,RCC.