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FQR(OFF CE USE. r ------------------ ------- ----"------- -- -- --- - ---_ . _- APPLICATION FOR SANITATION PERMIT -'Permit No. ../... . 3 16 (Complete in Duplicate) E... -------------------------- This Permit Ex fres 1 Year From Date Issued' 4 Date Issued'--- ll E 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 o. 549. lei JOB ADDRESS AN5i LO TIO ' - ' ----- -- --- --- ------- ----------------------------------------------------------------------------.--•---------------- Owner's Name - -•---' ------------ • - F ------ Phone-----------------------------Of ------- s t Address.............••- ----- ------- -r' r - - Contractor's Name-----}-_----.-_-_------•-------- ----------- ------------------------- Phone-----•-••-------------•----•----- Installation will serve: 'Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f-____ Number of bedrooms __ Number of baths ------ Lot size ......4�. ...._/`_S4_.._____...________ Water Supply: Public system [3 Community system� Private ❑ Depth to Water Table _ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date.-_ .F,_______)'' No ❑ New Construction: Yes ❑ No FHA/VA: Yes E] No El- s - TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t e ank: Distance from nearest well .--___--.__Distance from foundation____._________-_-Material___-___--_ ___________- le#d: Distance from nearest well-_-.___J_._____._Distance from foundation__.__-__._p:_.__.Distance to nearest No. of compartments-------------------------.Siz _ Liquid de th________...___ _ j� Barest lot line_________________ lJ Number oflines_r.:----------.-----------------Length of each line------T----------------------Width of trench----------------•------------------ Type.of filtermaterial-----____________--------Depth of.filter material____--------------------Total length---------------.--------------._.---....... J Seepage Pit: Distance to nearest well )yQx ,_____Distance m f undatlon��___�------Dista rce to nearest lot line_______-_.__ . fi '[ Number of pits-.-Y-------------Lining material--- i�f ------Size::iDiameter_,3'_3___/_-----Depth---- - ------------------- rr Cesspool: Distance, rom nearest well__-________�_Di tante from foundation"_____:__._'__.__.Lining material_____________________________________ f ❑ Size: Mam eter---------------- --=----AK---- Dept h---------------,--.`-- -------------------------------Liquid Capacity-- --------------------------gals. ❑ fance.from.Jnearest.building-------------------------------`---------- q Priv Distance from:nearest well__.__!_._._____�____________________________'_.:_Dis Distance to nearest lot line- ---------------------------- ------------- ------ ------------------------------•---------- ------ -------- ------------ 0 Remodeling and/or repairing (describe)------------- } `-----------------------------------` --------------------------;---------------------- -----------••---------------------------------------------------------------- -- - ---------- ------------------------------------------------------------ ---------- = ---- --------; - I I hereby certify that I'heve prepared this application and that the work will 6e done'in accordance with San Joaquin County ordinances, at laws, and rules and regulations of the San Joaquin Local Health District. " (Signed) , -`---------- - x an '/or Contractor) $Y:----------------------- ----------- -------------- - (Title) r ?- Ownee Y= (Plot plan, showing size of [of..location of system in relay n to wells, 6uildings, etc., can 6e placed,on reverse side). t r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--'- `, ------------------------------- DATE---------��c- REVIEWED BY--------------------------------------------- . . .. ------------------- -------------- --------------------------------------=-------- -•-•--•-----•--- DATE--------------------•---- --------...---------------------- BUILDING PERMIT ISSUED.-'.--i--'---------------- - --------------- -- ----_---------------------4 --------------- DATE-----=-------------------------k7------------------------ Alterations and/or recommendations:____-_. " — '_ s � < - _ __ __________ ________.. '__.._ -=:�_- ----- a - ;2� _ - -----=---- --=----------- ---------- -------------------- ------------------------ ----------------------------------•--•------ --------------------------------------------------•------------------------------ --------- -•---------- ------ ---------- -------- ------------------ FINAL INSPECTION- BY ~ � �� z� -- --------------- - " -- "'"�� Date- ------ ' -- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazelton Ave. 300 West Oak Street, `,3 ., * 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CO.