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FOR OFFICE USE: --------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ------- ------------------------------------------------- (Complete in Duplicate) This Permit Ex fres 1 Year FDate Issued __. From Date Issued OP( -- 2-6OrS Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. This application i made in compliance County Ordinance o. 549 JOB ADDRESS AND LOC (TION___. , Owner's Name _�_ iB, •-h..J'J Phone----•---------•---•----------- Address- --------------------------- Contractor's Name --•------••- Phone y -------------- ---- ._--._.--j Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [�C� Number of living units: __ _ umber of bedrooms __ __-- Number of baths __.- vim _ Lot size ._____ ____-.__.. ______________ Water Supply: a Public system ❑ Community system ❑ Private epth to Water Table{_ ft. Character of soil_to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ ay ElAdobe Hardpan ❑ It 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 Septic k: Distance from nearest well__-----.__ Distance from foursnd:a}tion _fG .______Mate/rial0_d_- NIC -- ------aNo. of compartments-- � � i---Size----- Li _u__id de th------x_ i —) Ef Disposal Field: • Distance from nearest we11...0...---.Distance from foundation_,�,!J__!-------Distance to nearest lot line_r�' _..____ 2 Number of lines______ 1-------------- /_Length of each line_/ � -d([/f +f7ti/idth-of trench --------- ---- Type of filter material ___ Q --_,Depth.ofwfilt��ma4erial_T_;��LTotal length__ ------------------------ Seee/ 0'3,_� t: Distar7ce to nearesfi well_____________- ___Distance from foundation___-_-_-__________Distance to'nearest lot line----------------- Number of pits______________________Lining material-------------_---------Size: Diameter--------- ------------Deptl--------------------------------- Cesspool. ------- -----------------•---Cesspool: Qistance from `A ---�Distance from foundation material'_---______-_________-----__------. nearest well_____________'-_ ❑ Size: Diamete` I Depth ,-----:-----f----Liquid Capacity_-------------------------gals. Privy: Distance from nearest well______ ________'__ '._.'___._____Distance from near est.building------- _ �" ❑ Distance to nearest lot line.----- - ` -----:--- '-------- -------------- --- Remodeling and/or. repairing (dascribe):-----___---------- +�t }__---- -__- � �, -------------------------------- -•------------------------------------------••-------------- -------•----------------------------------- ----- E ------ -------- ---------------------- --- ------- --------------------------------- ----------- -----------•---------�--e- ----------------------------=—=__` ------=- ---=�—# -------------------------- ------------------------------------------------- ------------------------------------------------------------------------------ ---------------- --------------------------------------------- - I hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules e s of the San Joaquin Local Health District. (Si ned } 9 }--------------- - -- -- - =-=-- -----•- -- - ------------------ ------------- ---------------------- - -------- .(Owner and/orContractor) BY=--------- � ------------------------------------------------(Title)--- p (Plot plan, showing size to , vocation of system in relation to wells, buildings, etc., can be placed on reverse side). • �. _� _ FOS DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY-------- - ---------------------- --------------------------------------------'----- --- �G DATE--------- �:�_ = [� REVIEWED BY ----------------- DATE --------------------------- ------- --- --------- BUILDINGPERMIT ISSUED.--!-------------------------------------------------------------- ------------ DATE ------------------------------------------------------- Alterations and/or recommendations:_____..______ -------------------------------------------- j ------------------------------------------- ----------- - ----------------------- ------------------------------------------ -----•-•-----------•--------------------------•----,-------- -------------------------------------------------- ------ --------------------------- r -- '-�FiNAL--IIVSPEC710N BY':- - - -- -. -:_.-'. �-----��-----'- -------' Date--- --µ----- -•------------------ _. - . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 i:.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California -Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 C,p,ED.