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FOR OFFICE USE: ------------------------------- -------------------- ---- • �'t I _____________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No.......1� e. ... -------------•------------------ A---------- (Complete 1n Duplicate) S �•" . 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 is made in compliance with County /Ordinance 7o. 549. JOB ADDRESS AN L CATION._..__. _ ___ ____ /.....__. .� / "..`` _ � .. Owner's Name ....... l -...... /J/1-�II!i._ .�"?.------•...-----•----------------------------------.............................. PA ......... -•--... Address.......... _.�.. _. .. _ Contractor's Name------ F............ u-c�z:-----•---...-•--•---- Installation will serve: Residence �) Apartment House ❑ Commercial ❑ Trailer Court ❑ otee❑ Other t Number of living units: __ (.... Number of bedrooms ..Number of baths .... Lot size _.... 0 G Water Supply: Public system ❑ Community system ❑ Private) Depth to Water Table /Q ft. Character of soil to a depth of 3 f l: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ 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.) Septic Tank: Distance from nearest well_________________ Distance from foundation .................... Material ................................................. ❑ No. of compartments -------------------------- Size -------------------------------- Liquid depth .......................... Capacity--....... ......••--- Disposal Field: Distance from nearest we} I____.__ Distance from foundation__ Distance to neerest pI� bine. o..._.. 14 Number of lines.............f ;___.___ _ ____�ength of each line ..... Width of trench ..... 7-........................ Type of filter material.14�y_ --- --- of filter material...---1--•----Total length.. .......................... 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 ..................................... V ❑ Size: Diameter -------------------------------------- Depth -------------------------------------------------- Liquid Capacity ............................ gals. Privy: Distance from nearest well _______________________________-------- ___------- Distance from nearest building .......................................... ❑ Distance.to nearest lot line------ ----•----•-----------•---------------••_----------------------•--------•---•----------•---•--------•--•--•-------•-----------------•--- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------�7 .............................................................. ------------------------------------ -----------------------•----------------------------------------------------------------------------------------------------------------•----•----------••-•..._...----•--------•-------- I hereby cerci y that I havepared this application and that the work will be >done in accordance with San Joaquin County ordinances, Sta w , and rul d �fions of the San Joaquin Local Health`^®wict. (Signed)------ - - _----------- -...... •----- -------------------------------------............................... ------------------------................. (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 -->/ f APPLICATION ACCEPTED BY... ------...i 42! '= DATE--------=�-- '-................................_ REVIEWEDBY ------------------------------------------------------------------------------------------------------------------------------ DATE-----------•----------------------•-----------......_ BUILDINGPERMIT ISSUED -------------------------------------------------------------- --------------------------------------- DATE ....................................................... Alterations and/or recommendations-------------------------------------------------------------------------------•---•-------------•----------------------------•------------------------•----••- ......................................................... -•---------------------------------------------- -----------------------------------------••-----------•-------•------•----------------------------•--••......---•- -------------••------------------...--------------••--•---........------ ------.. ---- -•--- -- -----------------•----------------------•--------------------•--------------------------------•-•---...--•-•- ..............r -.................................................................... 10 FINAL INSPECTION BY:.___ ---- Date-------_ -�..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 Wort 9th street Stockton, California Lodi, California Manteca, California Tracy, California ES 9 REVISED 8-59 RM 5-61 ATLAS