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FOR FFICE USE: __--_.---.__- -- APPLICATION FOR SANITATION PERMIT Permit No. - _- (Complete in Duplicate) _ Yv fy Y ---------------------------------------------------- - .._ 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 inst�l the wori-her -n descried. TTisppI' t' is made.in compliance with County Ordinance No. 549. ,� � ,vim JADDRESS AND LOC TIO .------- --,!� �_�/c �"ld��-_ ------ --- • -. f � Owner's Name-------- - -----• •-------••-•-•--•---------• ------------ -- Phon .-------------------••-----•-------- Address----------------••-----•• ....... --- . = ----- Contractor's Name-____-- _ _ .-_-- Phone---------------------------------•- Installation will serve: Residence [Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._/--_ Number of bedrooms -S-"Number Number of baths __ Lot size � ,e �_____________ ---------- Water Supply: Public system E] Community system ❑ Private:❑ Depth t Water Table. 4�ft. t 4' 01 Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes date..______.___._____) No New Construction: Yes V?"�No ❑ FHA/VA: Yes kq/'No ❑� ih TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well---4D/_,-s_-__Di5tance�from�foundation__Lp------------Ma erial_-&,®•e- No. of compartments-.1-------_ _-Size3 �4� " 7 --- - - -/�`--�,8�---Llquld depth--•- ---* --------------CapacitY��------------ Disposal Field: Distance from nearest well All �----- Distance from foundation/9_--___-___.Distance to nearest lot line_4._.._.__... ! Number of lines----c---------j__.._--.._____ Length of each line_x{e-- ------------------Width of tre,ch-A. .......................... Type of filter material-- / Depth of filter material_Xe ________Total' length__ _____________________--_. I 5eepag it: Distance to nearest well___l ____-Distance fr m foundation.��_____-__.Dist nce to nearest lot line_ Number of pits-`1_______________Lining material_ f 44__.Size: Diameter----' F........Depth ------- I 1`r I Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material-..._...._.________.__.______-______- ❑ Size: Diameter.--(----------------------- ----- ----Depth--------------------------=------- -------- --------Liquid Capacity- - ------------------- ..gals. Privy: Distance-from nearest well------------------------------------------------- from.nearest-building------------------------------------------ 1% ❑ Distance to nearest lot line---------------------------- ----------------------------- -------------------------••---------------------. I I Remodeling and/or (describe):------- 1 - --- r ---------------••------•---- = .-------- -••------•------•---------------------------- ------------ -----------=-------------------------------------------------------------- --- `. I ----------------------------------- --=--------- I l --------------------------- -------------------------:------------------------------------------------------------------------------------------------------------------------------------------- - � ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) I �-r Contractor BY� �,, (Title) - ----_. . . . (Plot plan, showing size of lot, lova+ion of sys+em ' elation.to wells, buildings, efc.,.can be placed on reverse side). ' FOR DEPARTMENT USE ONLY n v� APPLICATION ACCEPTED BY-------- --- ----------- - --------<----------------------- V DATE------- ---------- REVIEWEDBY----------------------------------------------------------- ----------------------------------------•---------------••------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------=-----------•-•-----------------==----------------------.. DATE------------------------------------------------------------- Alterations and/or recon a atio s__ ______ ____ _ ______ ___` [_______ ----------------------------------- -----------------•-- -------------------------------------- ----------.--•-•-------------------------------------------------------------- --- ----------------- k-- ----------------------------------------- •------------ ----- - ----- . ------------------ --------- -------------------------------- SAN _ FINAL INSPECTION BY: --------- --- `' Date- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,146zelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California VS 9 REVISED 5-59 3M 3••63 F.A.CO. -