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OR OFFICE USE: , ________________ _ _______ .___.._._.._..__..__ _.�,. APPLICATION ;FOR SANITATION PERMIT Permit No. ..l.-/l__-V_.--._ -------------- • _= Com lete in Duplicate] r c�� / P P 1 Date issued ---1-1-1.-!__-— .............. ......................................... This Permit Expires 1 Year From Date Issued t 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. JOB ADDRESS AND LOC I N - �:,..- /- Owner's Name �^- e Phonef - ,� Address------------_------- = ........ Contractor's Name-- � _. Phone. Installation will serve: Residence Xf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: -. .-_- Number of bedrooms -,2—. Number of baths -?---- Lot size .-.- -.-_ { ?.------------------------ Water Supply: Public system X Community system ❑ Private' " Depth to Water Table .60- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date--------------------- No x New Construction: Yes ❑ No (y FHA/VA: Yes ❑ Noex TYPE OF INSTALLATION AND SPECIFICATIONS;. , (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) Septic Tank- Distance from nearest well------------_-Distance from foundation-- ----------------Material-...__----------....---------------------........ F1r No. of compartments--------------------------Size----------------------------_---Liquid depth--------------------------Capacity---------------------- Disposal Field. Distance from nearest well ---.--Distance from foundation--------------------Distance to nearest lot line----------------- E] Number of lines------------------------------------Length of each line------------------------------Width of trench.-..-.-------.--------...___------_ s Type of filter material------------- -------Depth of filter material-------------------______Total length._:.--..--..--.-._....--.-..._._........-. 10 Seepage Pit- Distance to nearest well--- from',''�oundation__...1pJ__-..--..Di�ante two nearest lot iine__.44-----.---- Number of its_,-----_ Linin material-Se-j0 etc_kSize: Diameter_ �� ........-_ Cesspool: Distance from nearest well-----------------Distance from foundation---_------------ Lining material-______-------.--..----------------... ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 9 ❑ Distance to nearest lot line---------------------------------------------- ------- -/------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):--------t- .... --- - _ ------------------------------- --------------------------------------------------------------- ------•-------- ---------------------------- ---------------•-------•----- ------'--- -------- ---------------------------------------------------- -----------------------------------------------------------°-----------------------------------------------•--------.•--------------- ------------------------------------------------------------- ......................................................•----•-------•---.-..-.......-----..-...-.-..........----_._.-.--..._-__---.-..---.........-........-_-.-_----.-.-------•---------- ------------------------------- 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).___-------- -t -------' '' ``�'� (Own r and/or Contractor) BY: - ------------ (Title) (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------ 'DATE REVIEWED BY - -----------------------------------------------------------------DATE-----------------------------------•----- ---------------- BUILDINGPERMIT ISSUED-------------------------------------------�--------------- - -------------- D�-- ----------------------- -- --------------------------- i : Alterations and/or recommendations:------- `' `- � =-`�' 1 -ms`s ------ -p = -_ '� / -------------r ---...-------- -------------••----- -- ----- `----�f------ -----•--------------•--_..-------------------------------------------------------------------- - ------------------------------------------------------------------------------------------ FINAL INSPECTION BY: lc` �` —.:--- Date----- 1 -------� --------------------------------•---- rAN .OAQUIN LOCAL HEALTH DISTRICT RICT1601 E.Hosolton Ave. , 0 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-'53 F.P.Ca.