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OR OFFICE USE- c Permit No.------------------- APPLICATION FOR SANITATION PERMIT -------------_- (Complete in Duplicate) Date Issued .___l-_---..---�� ----- -------- ---------------- This Permit Expires 1 Year From Date Issue ct for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health Distri This application is made in compliance with County Ordinance No. 549- JOB ADDRESS AND LOCATION---- --- - --------------------------•------------------------------------------------ . , Phone------------------------------------ Owners Name---- -- --1-----�--- --•----- - I Address-...----------------- ------------ Phone-•-----------------------•-------- Contractor's Name------ --------------------- ------- PInstallation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /--_ Number of bedroom's .-.*2 Number of baths ---/- Lot size .___ ,/Z� ---------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableA.:rft. Clay Sand Loam ❑ Cla Loam ❑ Clay E] AdobeX Hardpan E]Gravel Character of soil to a depth of 3 feet: Sand ❑ ❑ y Previous Application Made: (If yes,date--------------------) Ido [3New Construction: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ------ i k• Distance from nearest well� =Dis#ante from foundation__________ _ ___-__Material------------------------------------------ No. of compartments---- - --- -----------Size---- --- ---Liquid depth-- Capacity Distance from nearest well-_&,Q 457 ___.._Distance from foundation--- to nearest lot line-_tib__-_.___. Number of lines-------,--------k-�---- ---------Length of each line----__�_-4_ -=-,-tee---Width of trench---------#9-�/*------------- Type of filter material J_iI-r� =Depth of 'filter materia4--__ __ ... .Total length_______________________ ® t r it: Distance to nearest well______________ _Distance from foundation-------------------- to nearest lot line___-_.__.______. .00 - ❑ # Linin material Size: Diameter Depth Number of pits------------------- g 04 Cesspool: Distance from nearest well_________________Distance from foundation -- - ---------------- materia_-.______---------------------------- els. ❑ Size: Diameter-------------------------------------Depth -------------------Liquid Capacity---------------------------9045 Privy: Distance from nearest well_________----------_____________________-__.___-Distance from nearest building-------------------------- l C] Distance to nearest lot line---- -------------------- ---------- ---- ------------- ---------- ---------------,---------------------- ------ - ----------------------- ,. I ? Remodeling and/or repairing (describe)_------------------_--------------------- I ---•-----•---------------------------=--------------------------------------------- -------------------------------------------------------------•------------------ --------------------------------- ----•---------------- ---------------------------------- i hat the work will be done in accordance with San Joaquin County 1 herel�ertify that I have prepared this application and t ordinanc 5, St a laws, an rules and regulations of the San Joaquin Local Health District. , ,t Si ned .,_. 2 ( wrier and/oi Contractor) ( 9 } • - ______(Ti _--.._ _�________________-..--------_ .__.--._...._ i $y:--------- ----------------------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, btfildings, etc., can be placed on reverse side).' I FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY________________ DATE----,::P-e � ------------------------ ---------------- -- DATE_------------------------------:--------------•------------ REVIEWED BY , BUILDING PERMIT ISSUED----------•'---------------------- ----------------------------------------------- --- -------------- DATE--------------------------------- and/or recommendations:.....---------- -- ---------------------------------------•------------------------------------ ------ --------------•-------------------------------•------- -------------------------------------- ............. --------------- -------------------- ------ ---/------- ;-r - - - ------- FINAL INSPECTION BY:----------- - -- ------ --- ----- ---------- Date-------=V1--=�� ------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20S West 91h Street 1 Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 9-59 3M 3-'63 F.P.CO.