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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .f.. ...Q -------- -- - ----------------------------------------- (Complete in Duplicate) r -------- This Permit Expires 1 Year From Date Issued 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. 549. A� -��---- JOB ADDRESS AND LOCATION.-----;---- ----z------------------�;f �- "---r'z�-!--...�Yi- _____.__- t - ' Owner's Name-- - Z -* -------•--- ----------------- ----------- ------------------------------- Address-- � j- a...07 -e..�'S ........ ....e - •- Contractor's Name- C �� r1--------_ i Phone. ? ............ � Installation will serve: Residents Apartment House ❑ Commercial ❑ Trailer Court ❑ M''ofttel ❑ Other -r[IgNumber of baths __-/___ Lot size ____.___ Number of living units: _______. Number of bedrooms �C�_ _ --------------------------------- Water Supply: Public system ❑ Community system ❑ Private [2' Depth to Water Table - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe 05_ Hardpan ❑ Previous Application Made: (If yes,date--------------------l No [31- 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__ __D__.-__Distance from foundation__.__________.Material---- _ ______________ No. of compartments q P. Capacity 6........ c�� ----- Size________/, �-----._--Li Liquid Field: Distance from nearest well Distance from foundation_.e, _�___YDistance to nearest lot gine-_ Number of lines______ ___ uR--___Length of each line_____ _�.___�_--�____-Width of trench.----- -.-_--_- ❑ -- Type of filter material_______________________.Depth of filter material-----ke__'-_-----Total length_____J_6_e,.)_____ ----------------- 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 __.___-.-.__.-__-__._.______________ ❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity-------------- -----------..gals. Privy: Distance from nearest well____________------------------------------------0)stance from nearest building----------------------------------.------- F-1 ___- -❑ Distance to nearest lot line--------- --------------------------------------------------------------------- ------------ --------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------ ---------•----- --------------- ------------------------------------------------------------------------------------------------------------------• ....--•--•----------------------------------------------------------------------------------------------- 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 regp lations of the San Joaquin Local Health District. (Signed.) ^ -. ------------- �? f rOwner and/or Contractor / `.t`? t�iil�r t C`"�d-s'-e(! r fx 4�}/I. - ` <. C t ec.e�-r (Plot plan, showing size of lot, location of sys in relation to wells, bungs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------ -- ---------------------------------------- DATE-------------------------- --------------------------------- REVIEWED BY------------------------------------------------------------------------------------------------------------- ---------------- DATE-- --------- ------------ - ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alteration's and/or recommendations:-------------------------------------------- - -----------------------------------•------------------------------------------------------------•------- --------------------- ------- -----------------------------•-••---------- ---------------------------------- ------------•------------------------------------•---•-------•------------------•----------------------------•-•- ------------------------------------------------------------------•---------------------------------- --------------------------------•----------------------------------•-----•------------------ -------------------------- FINAL INSPECTION BY-------------- —��Cy!!lvi� ----------------•-------- 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 U-59 3M 3-'63 F.P.Ca.