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FOROFFICE USE: _ r -------------------------------------------------- ------- ------------------------------ r._._..._.____---------- APPLICATION FOR SANITATION PERMIT ....Permit No. .__l '/. ' ----------------------------------------------------------- - (Complete in Duplicate), f ----------- --------- --- ------- This Permit .Ex fres 1 Year From Date IssuedDate Issued T _ X40 0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descry ed. t This application is made in.complian Re with County Ordinance No. 544. S C LO I JOB ADDRESS AND LOCATION___. - - --•- - - Owner's Name----- � ------- ��"'�_©_ ------------- ----------------------------------------------------- -------- Phone--,.? ---/---------------- Address---,...7---�---" -•.----- /Q _: k1' f :-d�L.� ' I `f-f Contractor's Name------ - f- Installation will serve: Residence E) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ # wt Number of living units: __1---- Number of bedrooms ._ Number of baths_____ Lot size ---------------------- Wafer __-_- • ----------Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table3 -ft. w: Character of soil to a depfh of 3 feet: Sand ❑ ,Gravel ❑ Sandy Loam ®' Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application TYPE OF INSTALLATION AND ONS. INQ SPECIFlCATI : 1 Na (Z New Construction; Yes E] No E] FHA/VA: Yes E] No L] i ( ` (No septic tenkIor cesspool perrnitted if public sewer is available within 200 Septic Tank:_ r Distance from nearest well_________________Distance from foundation--------------------Material S-45°Tl N6— No. of compartments--------------:------.'__Size---------------------------------Liquid depth-------------------- Capacity-------------- Disposal - __j Disposal ield: Distance from nearest well___,$ 1l-__---Distance from foundation.-_/ ____._.Distance to nearest lot line__. ___.:__ Zo Number of lines---------- Length-of each line_"?'__`�'R �___--_--Width of french---__sR__V�/.____.::_:__-_ — Type of filter material-_.F /�-----_Depth.of filter material-------------- Seepage Pit: Distance to nearest well---------------------- from foundation___' ___.-________..Distance to nearest lot line------- ❑ {Number of its____________ _ p ------Lining material_--------------------- Size: Diameter---------------------Depth------------------------- ------- , _ Cesspool: Distance from nearest well-----------------Distance'-from.foundation____________________Lining material-_..-______-_________--_____________ . ❑ Size: Diameter--------------------- -- � - - Depth_' -- ---------------------------------------Liquid Capacity---------------------- -gals. Privy: =' Distance from nearest building Distance from nearest well------------------ ;. 9------•--------- ------=--------- - ---� ❑ Distance to nearest lot line-. Remodeling and/or repairing (describe)---------------------------------k -----_----- :: ••------------------••--------------------- --•---------- ----------------- ------;.I ------.-------- - -------------------• ----------------- ----•---------- ------------------- ---------•--------------------- ------------- i I hereby certify that I have prepaed this application and that the work will b_ done in accordance with San Joaquin County r, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - . (Signed)---- - / 1----- Q-_�1_C ' F' ,�7,i�' p - .. - ------------------------ _- ._ _( wner and/or Contractor) ----- - - J-------------------------------------------- fJ!v (Plot plan; showing size of lot, Io ton of system in.relation to wells, buildings, etc.,.can.be.placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y - - "----- -------------- - ----------------------- REVIEWEDBY-------------------------------- ------------------ -------------------------- - -------------- ------------------------ DATE--•--- ' BUILDING PERMIT ISSUED -------------------- ---- ---------------------------------------- DATE Alterations and/or recommendations_--------------------------------------------------------------------------------------- ------------ " :.<:[r" ------------------------- -------- ------------ -- ---------- ------ OL ---------------------------- _ s FINAL INSPI CT L��Q Date / _ _-� .` SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Co. 1 _ I