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FOR OFFICE USE: ------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _�- --------------- --- -------- ------------ -------- (Complete in Duplicate) II c , Date issued ____-___-.. -_ .---------------------------------------- ------_. This Permit Expires 1 Year From Date Issued 017, [.SO-30 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worrein described. T is application is made in compliance with County Ordinance No. 549. a €trTr�,�. l�, t r JOB ADDRESS LOCA ION�_. _ '- �' 'u! . ----------- f -- ---- Pone------------------------•---------- Address-------- =�-- 13- ---------- � �----•-�-----------------------------------------------•---------------------— f - Contractor's Name----- " `= •------- ------ Phone................... ........... IF Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ li Number of living units: _.___ Number of bedrooms A_ Number o 'aths Lot size __.__ Water Supply: Public system [I Community system El Private Depth to Water Table _ ____- ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam I ay ElAdobe C] Hardpan F] Previous Application Made: (If yes,date__.__.__..,--------) No ❑ 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_________________Distance from foundation_•___-!_-----------Material-______..____-_-_________'____:___.._-----____. ❑ Zf -_Liquid de th------------------ -Capacity �� No. of compartments---------------------------Size------------------------•---- q i P ------ ---- ---------------- Dispos Field: Distance from nearest weil__��_r._Distance from foundation.____/0_-r-._.Distance to nearest kat line__ __ __ a Number of lines--------- °___ .____ Length of each line------ Width of trench._----�___,-___ ______________ ' � !_ r Type of filter material=___.-. _ .__-Depth off ilterfounda#ion_ _ ------------Distance 9ohneares 1 e_______________. om 9 ...Size: Diameter------------------ ---Depth----------------------------•--- r Seepage Pit: Nutmberr of pits rest well-------Linin material e------------- ` s F4 Distance from nearest well_________________Distance from foundation_---__ ------------Lining material----_-__-____-________-.----_______-. v P ' Cess❑oo : Size: Diameter--------------------------------------Depth-------------------------------------------'-----------Liquid Capacity----------------------------gals. I Privy: Distance from nearest well---------------------- --.--------------:____-----Distance fr'yom nearest building------------------------------------_--. ' ❑ Distance to nearest lot line- ------ ------------------- --------------- ------------------=----------------------------------------- A� Remodeling and/or-repairing {describe):_____.____ - s -I[-------------------------------------------------------------------------- r J' t ------------ I t L. ------ •--------- = -------------------------------------- ----------------- Il y -- y -----?,, rules --------—---p-------•----------PP:---------------------- -----------------------------------•-----------------•--------•--------------------------------------- ! her eb cert t ave re ared thisa lication and that'the work will be done in accordance with San Joaquin County ordinances, State and regulations of th an Joaquin Local Health District. '' `=' i5� --------- lY----------- �e�r and/or Contractor) (Signed)_ - - --------- BY= - - ------ --- - -- (TitlePlot lan. showing size of lot, location of system in relation to wellsetc., can be placed on reverse side]. ( P FOR DEPARTMENT USE ONLY n - APPLICATIONACCEPTED BY------ -- --- -- -- - - - --- ------- ---------------------------------wL_ DATE------�- -- ------ - ----------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- - = - —--------------------------------------- µ - ; `_ DATE -_ DATE------------------------------ ---------------- ------------- Alterations and/or recommendations----------- ---- ------- - ------------------------------I� •-------••------------------------------------------------------------ ------------------------- -- =- ------- ------------ -------------------------- ------------------------------ ---- --------------------------------•------------ --------------------------- -------'--- -------- ------ ------------ - -------------------- FINAL INSPECTION BY:.--.- • ' `-----� Da#e__�!__ - _6.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan Ave. 4 ' 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California le ES 9 REVISED 9-59 3M 3-'63 i.P,CG. !`E�