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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT Permit No. .1_.f�_ _ ------------ _l_,_r I -_ - -it: (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued 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 is made in compliance with County Ordinance No. 549. s; JOB ADDRESS AND LOCATION---��--_--._. / ---_--_-- .3_��. ------ Owner's Name---- --- ---------------------------------------_- ...... -- -----. Phone------------------------------------ Af * tZ ------------ '� �+..L � s,t Contractors Name.---- '' ,.�,,,,�.,- -- - -- •- "='-•- --'�---------------•----•-•---... Phone----------------------------------- Installation will serve: es�e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other [INumber of living units: j----- Number of bedrooms }�____ Number of baths __�____ Lot size -_t--------------------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 211X ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeM Hardpan ❑ Previous Application Made: (If yes,date--------------------) No fO 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.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_-_-.___-_-___.___-__.___-.-_--------_._._..... ❑ No. of compartments--------------------------Size-------------------------------.Liquid depth. Capacity----------------------- Disposal -Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- W ❑ Number of lines-----------------------------------Length�f each line___________ _____________.Width of trench:._...._____...___________________ IJ Type of filter material:__ .--_-__ ____.___Depth of filter material-__________________Total length___..__._______.._.._-__.._._..____..__._ Seepage Pit: Distance to nearest well---/&V- ____-__-_Distance from °undation---LO..........Distance to nearest lot line_........... NNumber of pits-----f----------------Lining material-,, -----Size: Diameter-------. - ___--Depth---;-. --------------------- to Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity --------------------- gals._. Privy: Distance from nearest well. _ ___ __ ________ _____ ___ ______ _Distance from nearest building------------------------------------------ El --.--..-._______-__________.. -__._.❑ Distance to nearest lot line--------- -------------------------------------------------------------------------------------------------•---------------•--•------------ Remodeling and/or repairing (describe):__ ------ ..._.i ..i � -•-•------------------------------ ------ ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) `- --------------- --------------------------------�' -U C .---- ---------------------------------------------------------(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). FOR DEPARTMENT USE ONLY PIP APPLICATION ACCEPTED BY---- - ---------------------------------------------------- DATE... rt�"_`- �tr*ti�------------------------------- REVIEWEDBY-------------------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------- --- ------------------------------------------------------------------ DATE-------------------------- L =.r2 iE' •�Zf-l` •- :`>: � -A,/ ` - .---.--_l_-y�---- � �_Alterations and/or recommendations:...._..... -------------_X__1 ---- ----- �- 4ev� ----`"f {,. .--------------------------------------->'- ----`-=-�-�--!-i•-�-_- _ � '.E ----------------- ------------ ------------- -------------------------------- ----------•-------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- Date_.. "e�� ------------------- FINAL INSPECTION BY: ---r3O!O ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.