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OR FFICE USE: -- --------- -- --------- �-� ? �( Permit No. .... .. / / I --------------- - fly_- APPLICATION FOR SANITATION PERMIT 2 ------� I l 1 --------------- (Complete in Duplicate) ----------------------------------------- Date Issued ______1_ /� �f ---_-----------_________________________________-___.__. This Permit Expires 1 Year From 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. --------------•-••-------------------------------•--------- JOB ADDRESS ANDleAlZ10 CATlO ..__�_!- --�--•�. - -- -- -----�-- - Phone- Address hone-- Owner's Name------------- -��-- - l� - ---- ---------------•---A--•�------------- - ---------------------- --"--------- -- --- -- - � Address-----•-------------•-•.. --- pp,,��L----- - ...----•- Contractor's Name ��--71. �`-4 *�� 4 `�' ----.--•-------------- Phone r Installation will serve: Residence �-impartment FTouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .c` Number of. living units: j---- Number of bedrooms ___ Number of baths j---- Lot size _ Water Supply: Public system �mmunity system ❑ Private ❑ Depth to Water Table a_Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan El 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.) S is Distance from nearest well_______________Distance from foundation___________________Material----------------------------______________._____- .�r ---------Size---------------•----------------Liquid depth`I------------------------Capacity---•---------- ---- No. of comparfinents________________ - ' D• o e Distance from nearest wellA0kt -_.Distance from foundation___ :____._.Distance to nearest lot line__ ---�..._. Number of lines______ ___ ___�__`.._ . Length of each line--30--0 __---------Width of trench_,Z__V�Y__.____ Type of filter materials s.a__ __Depth of filter material________-.-___Total length______________ _______��______.. � Seepage Pit: Distance to nearest well At_0q+tR.,_____Distanc�from foundation__ __.Distance to nearest lot line_Z�or S 1 } Number of pits.__------------------Lining material _' ----.--Size: Diameter. �[ Deptn__ _p�____-- ------_--. i Cesspool: Distance from nearest well___----------------Distance from foundation--------------------Lining material--------------------------- ' ❑ Size: Diameter----------------- --------------------Depth-------- ----- -------------------------------------Liquid Capacity---------------------- gals. i I Privy: Distance from nearest well_______________________________�'.__-___------Distance from nearest building--------------------------------.-______i6 ❑ Distance to nearest lot line---------------- ----- ---=- --- -----t-----�------------------- -------------------------------------------•-------------- {! Remodeling and/or repairing (describe):- ------------------- ------------ -- ----------------------- - ------ ----- ---------------------- ------------------ ------------------------------ ------ -----•------------------------------"------------------------------ --- ------------------------- ---=- ------ -- -------------- - ---------- ------ - - - ----------------------------------------- ` ----•---------- --------------------------------- ------------------------------------- ----------------------------------------- - ----------------------------------------------- -------------------------.------------------ I hereby certify that I have prepared this application and that the ark wil€ be done in a cordance with San Joaquin County ordinances, St t laws, nd rules a regulations of the Sa a in Local ealth District. i t (Signed)- ---- ---------- ---- - --- '- n - i -` �n -=a1►d,Ln ntractor) I - By--------------------------------- -----------•-• -------------------------------=------ _ (Ti+le) - (Plot plan, showing size of lot, location of system in relation t ells, buildings, e+c., an be placed on reverse side). e. { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ------- DA7Ef j yt REVIEWEDBY - ------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED ----------------------------------m ------ --------- ---- ----------------: DATE---------------- ---.----------------------------------- Alterations and/or r comendations---------------- - f qq - ------. ------� f� rc --------------------------------------------- ---------------------------------------- ------- --------------------------- ---------------------------------------------------------------------------------------•----------------- ------------------------------------ - ----------------------------------------------------- -------------- --------------- ------------- ---1---------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- ------ Date_ --------------------------------------- rANOAQUIN LOCAL HEALTH DISTRICT _ I 1601 E.Hoseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M.3-:63 F.P.CD. f