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FOR OFFICE USE: --------------------------------------------------------- �7 APPLICATION FOR SANITATION PERMIT Permit No. .Z _____--_--- _ � - - (Complete in Duplicate) �� T� y Date Issued ------------- ----------------------------- -_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t6 construct and install the work herein dAgj1;led This application is made in compliance with County Ordinance No. 549 :. JOB ADDRESS AND LOCATION----_'7'..-----.......C.O----------- � Owner's Name- - T)t,,- ��_� � Phone_� :_33'7 ---------- ---------- ------ --- ----- ------------ Contractor's Name----- -------------------------- ---••--------------------- --•-•-------------•-•-- ------•----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living .units; A---- Number qf bedrooms _. Number of baths --'" "Lot size _-----�,'------CLC ----- ------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand E] Gravel#❑ San y Loam Clay Loam ❑ ; Clay ❑ Adobe❑ Herdpan ❑ Previous Application Made: (if yes,date---------__--------) No r!2" 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 00 feet.) ; Septic Tank- „. Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------ ----------- No. _ _-:a- ..No. of compartments--------------------------Size---------.-_-__------------_-_-Liquid depth ------------------------Capacity------------ -------- Disposal --- -_-__---_------Capacity- Disposal ie l Distance from nearest well- _t4` .- Distance from foundation____/V!__:_--Distance to nearest lot line _.__ Number of lines- ------1------------- ------Length of each line-------15'Z_------------Width of trench - Type of filter mate :-_Depth of filter material-_-_..e-----Total length-_- ___-.__-�' Seepage Pit: Distance to nearest well_-------------------Distance from foundation....................Distance to nearest lot line__----_- s' Number of pits___-___--_---_---Lining material--._-- --. ---_-------Size: Diameter----------------------Depth--------------------------- Cesspool: ---_-----. -Cesspool: Distance from nearest well-----------------Distance from foundation------ -------------Lining material------------- ,`� ❑ Size: Diameter----- ------ --- ---------------Depth--------------------------------- ------- - --Liquid Capacity -------- •---------_9 Privy: Distance from nearest well __-----____--_-_----------------------------Distance from nearest building-------------------------------_-----_---. ❑ Distance to nearest lot.line-.-----------------------------------------------------------------------------------------------•----------- -------------------- Remodeling - ---------Remodeling and/or repairing (describe):-------- ..... .......-Q_ �� .----------------3--------•- ---------------------------•--- S> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- --- --------------------------------------------- 1 hereby certify that I have prepared this application and that ther-work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. (Signed) ------------ ; -- - Fes_-' --- (Ow er and/or Contractor) f �* BY:--------------_- ' ---------------- �` 1. ---------- - ........----------------_--(Title) -_ - Plot Ian showing size of lot location of system in r ation to wells, buildin s, etc., can be laced on reverse side). ( plan, 9 � Y 9 P ) ;j FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY., ------------------------------------------ --- -----------_---- DATE------ -----:a`------------------ --- --------------- REVIEWEDBY------------------------------- -------------------------------------------------- ...... DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------............... - - DATE------------------------------------------------------------ Alterations and/or recommendations--------------- -------------------------------------------------------------------------------••-------------------------------------------------------------- FINAL INSPEC ��- --------- -- Date-----------------� /�=---- ----------- 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 ES 9 REVISED 5-59 3M 3-'63 r.P.CD.