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FOROFF[C ----------------------------------------- .�--_?:-_- APPLICATION FOR SANITATION PERMIT Permit No. _-. ................. --------------------------------------------------------- (Complete in Duplicate) / 7/ ------ This Permit Expires 1 Year From Date Issued Date Issued ..... j zr Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. C-7 - - ZZ � C OB ADDRESS DATfON _ _ _l r , - --te t. _._ f �,. A � �e, Owners Name ! e' � Phone -----------•--...... Address .......... a-------------------------------------- ---- . ... _ Contractor's Name... -------------------------- Phone.................................... i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C] Number of living units: _/-• Number of bedrooms J._ Number of baths a2o-- Lot size Water Supply: Public system ❑ Community system Private Depth To Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] Previous Application Made: (If yes,date____________________) No Ep'' New Construction: Yes 23"'No ❑ FHA/VA-. Yes 9?00,*,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___f 'AP....Distancefrom fpundat' n----/0-.____._.Material___ - 1` No, of compartments___ _ ____________ N _ _size Xek. Liquid depth_--___IV__..__------Capacity,4-,r_�.,�W... I Disposal Field: Distance from nearest r�well __* ___ Distance from foundation__Zi��______...Distance to nearest lot line.. Number of lines__tce�___�______ ___--- Length of each line_.7t�___�-. _` Width of trench._r__��__f.______ I T e of filter material.� � ,r /� '' YP - _ _.Depth of filter materral____./r�.__.____Total length _�_____ _____________• Seepage Pit: Distance to neare;tl,rr��well----,C��---Distance f,Qm fou dation__ ! a�j...-...Dist nce to nearest lot ii f_�P�__ __ [ }� Number of pits___-a---__--_____Lining�mster�L-,/ Size: Diameter_�J.._.--------Depth_ .�___•_-___.____-__ Cesspool: Distance from nearest well-=______________Distance from foundation...._._.-----------.Lining material----------.._______________----•---- ❑ Size: Diameter -i ------.Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line 4- Remodeling and/or repairing (describe):---- ........................... ------------ ------•-------•------ ------•------------••----------------------------•----------- I-•----------------- ------•-----------------------•-••------------------- or - ----------------------•-I-----------------------•---- ----------------•-------•-------------•----•----------------._...-----------------•-----------------------•-----------------••-------------------- hereby-certify that I have prepared this application and that the work will be done in accordance with San Joaquin County dinan•ces, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ="= --- ------ --- ---------------------------•-----•------- .•• # ------------ Qr Contractor) a.gY�---------------------------------------------------- -------------------- (Title)_. .1 (Plot plan,.showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY.___ -t. DATE '' REVIEWED BY - _.____ _ ___ _ ---------------- ---•--- -------------------------- -------------------------•---------------------,DATE -------------- BUILDING PERMIT ISSUED------------------ -•------------------------- - --------- DATE.-------------•-- Alterationsand/or recommendations:_:____ - P�z� t� L lye yam✓ - -----•----------- ----tr✓ - -, - ------ C_�'� J _ - �'+---- ---••------------ ---------------------- -- -------------------- --------------------- Z_ FINAL INSPECTION BY:.----L.--:`Y' -- ----- Date------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT a 130 South American Strout 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS