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FOR OFFICE USE: -. --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.,l .:Z_./._ 7 -------- ----------------------------------------------- (Complete In Duplicate) / i..._.___..___._-- This Permit Expires i Year From Date Issued � � Date Issued .� /1 .•.. P - 7�5�—r 7 . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION,C_ ' Z_ '"9".9 y .` - �._ ---- ._ ----------------_-1 1- ____/. J Owner's Name "�" -------------------- ----- Phone------------------------------------ Address--------- .......... ---•---------- -----------••------•----------• -------------••--------------------------------- Contractor's Name--------------------------- �. = ----------- ------------ --------- Installation --•----Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /--__ Number of bedrooms Z-- Number of baths -/- Lot size .___0/1 -�_-- - Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table--t/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) #eTam Distance from nearest well_________________Distance from foundation________-_____._.__.Material-_____._ -________-_...______________..____.__..No. of compartments--------------------------Size-------------------------------Liquid depth------------------------s Capacity---------------------- � j � R Distance from nearest well_.5--lo_____Distance from found tion__.....6-__._.._.Distance to nearest lot line_____________ Number.of lines----� ------ .. Length of each line_ _�� .Q_�._.Width of trench-._-_--�_ _��--•---_------ Type of filter material--,��tP- epth of filter material__J-Z_--!-------Total length_______ Q_______-___________- Seepage Pit: Distance to nearest well------ ---------------Distance from foundation--------------------Distance to nearest lot line_______.__.______ ❑ Number of pits----------------------Lining material.......................Size: Diameter----.------------------Depth-----------.----------.---------- rb Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._______.___-_.____________________- ❑ Size: Diameter----------------'---------------------De Depth------------------ ~ ---------Liquid Capacity gals,___.______ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line :- ------------------------------------------------------------------------------------ (I'1 Remodeling and/or repairing (describe):------d------ ------------------------------------------------------------------------------------------------------------------------•-------------. s (. ice- --- ------ r. ------------------------------------•---•---------•--------------------------•----••--••------- -------------------------------------------------------------- - -----•-------- ------------------•------------------------------------------------------------------------------•-----•--- ------------------- --------- I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, and rules and regulations of the San Joaquin Local Health District. (Signed) r------------- - - ................`. = •------------- - ------------------------------------- Owiier and/or Contractor) BY�---------------------------------------------- -- ------ ---- -- ------ ---- - ---- ---------------(Title)- ------ •--------------- -------- ----------- (Plot -(Plot plan, showing size of lot, location of system in relati n o we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ��LL APPLICATION ACCEPTED BY 14 - DATE------.rf-_rl �p --------------------- -- --------- DATE-------- ----------------- REVIEWED BY------•------------------ ------------- - ---- -- - ---- �- ---- -- -- --- •-- - --------------------------------- BUILDING --••-•-----•------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------- --------------------------------------------- ....---•-- ------- --------------------------------------- ----- J - f�� - W-0-5n------//l��T-:5T -eD-----A-��-------.4a.11�II�-+. ---------- -- +�-0`I�l EL-)----------P R.r R 7 A4A _ ------13;F 1-.�------FrG .----•-Sf�_ml.U.0.13 __ 1 .MED____-- ------ r,�_�_._------.��.Q_______________________________________________ ..__._______._._____________.._ ______________________________________ _____ _________ ----- ------- _- _ ._.-._.__-.__- ---.-_._-------------------------------------------------- ----.-___..__--____._---.-------_-- ---__.--_-- _-_.__--___________.._.__.__ t f FINAL INSPECTION BY:. :, 1-- ------- --- - - Date--.-------------f_.Its-- - .J_ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street i Stockton,California Lodi,California Manteca,California Tracy,California ESS 9 REVISED 8-S4 3M 3-•63 F.PXD. ` �'P