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FOR OFFI E SE: APPLICATION FOR SANITATION PERMIT Permit No. ...... 1........::..... ----------- ---- -------------- ----------- (Complete in Duplicate) 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 No. 542. . r e JOB ADDRESS AND LOCAT]ON___/-- Ilo4r - ----... '._.. Owner's Name---- ----------------------------------- -- ------------------------ ------------- Phone -7=-'�' ,74- Address ----------------------------------------------------------�----- ----------- Contractor's Name---------------------------------------------------- -------r--------------------------------- Phone---------................ Installation will serve: Residence Apartment House Commercial TrailerCourt Motel El Other Number of living units: _-.. Number of bedrooms. --. Number of baths Lot size -- -s- ---------------- -------------------------- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table $p ft. Character of soil to a depth of 3 fee+: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ k Previous Application Made: Ilf yes,date....................} No ❑ New Construction: Yes ❑ NoW FHA/VA: Yes ❑ No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sg 'c jTank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------_--------. No. of compartments-----------!--_----- ------Size---------------------------- ---Liquid depth-------------- --------Capacity..------ Dispolalield: Distance'from nearest welL&A!!?_---.-Distance from foundation_-447-------.Distance to nearest lot line-------Q__-.. :-_ -- Len th of each line----__ - I -� _Number,;of.lines---- ------------ g �1--_-____-_«___.Width of'trench---aR--V-,- N . Type of filter material- �- ---Depth of filter material length__----------------�0-----------.- � � .. - - - 6. Seepage Pit: Distance:fo'nearest well_/,0----------Distant rom foundation_-3-a---.___.Distance to nearest lot Number'-of 'Pits------ ------------Lining ma+erial- -_ SzE: Diameter- Dept line-----.-.------.------- F.:. Z Cesspool Distance from nearest well-_------I-------Distance from foundation--------------------Lining material-------------------------------------- El i Size: Diameter------ --------------- ------.Dept h----------------------------------- ----------------Liquid Capacity-------------------------- gals. Privy: Distance from nearest well ---------------------,_--_---__._.-=.-Distance from nearest building-----------------------------------_--.-. ❑ Distance^to nearest lot line........!------------------------------------------ ---" = -`---------•- ------------------------------------------------------- - Remodeling and/or repairing (doscr&):__.'_ --._.'*----------------------- ------•------------------------------------- - ----------------------------•---------------- ---- :: --------------------------------------------------------�._.p_....------------pp---------------------------------- -----------------------•-• -------------------------- ----------------q--------------.... I hereb if that I Have prepared this application and that the.work will be done in accordance with San Joaquin Count ordinances tI laws, and rules and regulations of the San Joaquin Local Health District, r Si ned ---- ----- -------- ------ - - -------- ------- Owner and/or Contractor ( g )----- -- -- --- - ------ ( / 1 Y��J .-'f By:. - Ti+Ie-- (Plot plan, showing size of lot, location of system in relation to wells, bu' Ings, etc., can be placed on reverse side). + t i OR DEPART NT USq ONLY I APPLICATION ACCEPTED-8 --------------------------- DATE--",--'---- - -- ---- _----- ----------- --- -- -- - REVIEWED BY-------------------------------------------------- ----------------- ------ -- ------------_- DATE------------------- --- • -- f BUILDING PERMIT ISSUED------------ ---- ------ --- -- --•---- --------- DATE----`!------------------------- ------------f--------- ----------------- --__-- -��- - �.- ---• ----._--- .------------.-.--•-------•-- t # i ------------------ Alterations and/or recommendations:_ I +----------------------------------------------=- ------------- -------------------------------•------ ------ --------------------------*------------------------*--------- -•--------------•------------------------------------ ------------------------------- ---------- ---------• ------------------------------- f 1 1 ------------------- FINAL INSPECTION BY ----------- --- --- Date -- ---- ==-=--------------------#---------- /SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street, 124 Sycamore Street S 205 West 9th Street Stockton,California Lad!,California Manteca,California { Tracy,California c ES 9 REVISED 5-59 3M 3-'63 F.P.CD.