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FOR OFFICE USE: _-_ APPLICATION FOR SANITATION PERMIT Permit No. _----- -------------------- ------------- ____ ------ (Complete in Duplicate) 1� y - Date Issued ----- A --------- ---••-----�� ._.. ___. ---.--- This Permit Expires 1 Year From Date Issued Applii<ation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. . This i plication:is-made'inicompliance with County Ordinance No. 549. JOB ADDRESS AND LOC ION .2"t—___/A44445' .- '' -�'---- '� ----" �``" �-u• . Owner's Na -------------- Address - ---- - - -9�-------------- •---------•--�---- - - ----=---------- - - Phone------------------�.---------------= Address---- `fit -----` j.. Contractor's Name_------------- r ---------------------- -------------------- Phone-------•----------•------_-------- Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ ! Number of living units: ___ __ Number of bedrooms _ Number o baths _VLot size ________________________ Water Supply: Public system ❑ Community system ❑ Private FIR Depth to,Water Table_______ 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 ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from-�nearest well_________________Distance from foundation--------------------Material ________._.________..._...__________.__________- ❑ FiNo. of compartments-------------------------Size_-__-------------------------Liquid depth---------------- ---Capacity------------------------ Dispos eld: Distance from nearest well., _--_-.-.Distance from foundation-------:A.......Distance to nearest lot li e.-X......... Number of lines----------- .. Length of each line.....:_' - __ Width of french....... �___---_---_-_-___--- -_Total length___.__._'"!--_______-.__ Type of filter material___ ---------------Depth of filter material___.__1__ ______ es � � ' age Distance_to-rsearest well______________ _______Distance.from foundation-_-._____________�Dis�ance t� nearest lot lin j_-__ . ❑ Number o pits=�''° -------_Lmi gLmaterial___�-f°"T'�.Size: D+s�eter----�-�(.-- ----Dept h-----/�----_----:- Cesspool: D'stance fibra nearest,well------:Distance from foundation--------------------Lining - , �- materia l__________________________;__._______ ❑ Size: Diameter------ ------------ De�h"-'r' ----- -----------Li Liquid Capacity----------------------------gals . Privy:. . Distance from4nearest well-_..-_-----------------------------`-------"____Distance from nearest bu;.Id;ng------------------------------- ❑ -------"._.. Distance:to�nearest lot line-`--�='::---------- --------- _- ---------------------------------------------------------- - --- ----- --- ----------- Remodeling and/or repairing (describe): .------------------------------------------------------------------------------------ T _ r ---------------- -------•------•-•----------------------------------._---- -------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courity ordinances, State I nd rules and recplafions of the San Joaquin Local Health District. (Signed)--------------- � V"---------------------------------------------------- d/or Contractor) t By:--------------------- - -------- �CfL --- - -- --- (rtle) _ ._ [Plot plan, showing size of lot, location of system to relation to el"w Is;,buildings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- DATE-- D 1G�------------------------- -- REVIEWEDBY-------------------------------------------- --- ------- ---------------------------------------------- DATE--------------------------- BUILDINGPERMIT ISSUED------------------=-------------------------------------------------•------ -----_-------------- DATE.----- ----------------------------------------------------- Alterations and/or recommendations---------------- ------ ---- - -------------•--------------------------------------------------------------- -----------------------------------------'-------------------------------------------------------------------------------- --•------------------------ -•---------------------------------------•-•----------------------__. ----------------------------------------------------------------- ------------------------------------- ----------------------------------------------------------------------•---------------------------------------------- ------------------------------ --------------------------=------------------------------------------ --------------------------------- --- =_------------------------------------------------------------------- FINAL INSPECTION BY: ----------------------- Date__--------__r. SAN JOAQUIN LOCAL HEALTH DISTRICT ii 1601 E.Maselton Avo. 300 Weal Oak-Street-r_ �Ij 124 Sycamore_Street; 205-W est 9th Street Stockton,California Lodi,California Manteca,Coliform Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.CO.