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FOR OFFICE USE: -------------------------------------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. .. .. .d ------------------------------------------ ------------- (Complete in Duplicate) J ------------- '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 install the work herein described. This application is made in cpmpliance with County Ordinance No. 549. 02� �; JOB ADDRESS AND LOCATION. _�_�--:tea _-- / r,�.cJ`Lf - -' ------------ --- - ------ ----- -�-� Owner's Name------- _4,01 _ ------- _ Phone------------------------------------- Address--------------/_-z/-----------5...--•- ,. / I Contractor's Name----- --------------------- ---------' ------------------------------------------- Phone.............---•-------- - Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel El Other ❑ Number of living units: __I/__ Number of bedrooms _Number of baths I____ Lot size _.C�-L�-�.�.�--------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _-Zq ft. r. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam. Clay Loam E] Clay ❑ Adobe❑t Hardpan ❑ Previous Application Made: (If yes,date-----------,--------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic T lc- Distance from nearest well__.rS_d_r_ Distance from foundation-----1__�_-____.Material_.._.__ -.,____ No. of compartments_____--`7--_.--_____-Size__X----J_�J_C.cV_Liquid depth-_._ .f..-..___._.__Capacity____ a_Qe " Disposal field: Distance from nearest well._Sq.1----Distance from foundation-----J.:Q_1_-'Distance to nearest lot line__t ----------- [ Number of lines._____._ g 4 / Len th of each line____ --_...___._.Width of trench.._._ �_______________________! ., Type of filter material___ _- - __ ,___Depth,of filter-Material------!_i ._........Total length_____ ------------------------11%�,� Se epa e Pit: Distance-to-nearest;well'---- - Distance from foundation-----1__d Distance to nearest lot Number of pits----- -----------Lining material ---------Size: Diameter-------3 --------- e 40 Depth_ Q__------------- Cesspool: Distance from nearest well_________________Distance from:foundation-----_.----------- Lining material__._-----_---_----------.------- (.f0 x «C...��000 ❑ Size: Diameter---------------- ---°-;n- -------Depth-----------+ ;------------------=--------------Liquid Capacity-- --------------------.---gals. Privy: Distance from nearest well-______�_:_____�_________________._____ DistanceDistance to nearest lot line --- - -------- '----------------------------------------------------------------------------- Remo cleiing --------------------------------•-Remodeling and/or repairing Idescribe} __ ______ - --- a --------------------------------- •------•---------- ---------------------------------------------- ----------------------------------------------------------------------------- •----•-- ------------ --•--------------------------•-------------------------------------------•---•----------------------------------- - _--------------------------_-----------------;--:----------_-----------------------_•------------- = = _ =—--__------•---------------------------------------------------------------------- T I hereby certify that I have prepared this application and that the work will be done in accordance with'Sari Joaquin'-County ordinances, State laws'. and rules and regulations of the San'Joaquin Local Health District. ----- (Signed)- --------- - --- -------- -- nd or Contractor ----------- -------------------------------------------- By:------- ---- --- -=--- --------------(Title)---------------------•----------= ----- - ------ ;---------- (Plot plan, showing size of lot,.location.of system in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------ DATE--- ------ 0--i- -- ------------------------------- REVIEWEDBY--------------------------------------------- ------------------------------ ------------------------------------------------ DATE------ ---------------------------------------------------- i BUILDINGPERMIT ISSUED----------------------=------------------------- ----------------------------------------------------- DATE------------------------------------------------------------ I Alterations and/or recommendations-------------------------- ---------------------------------------------------------•-----------•----•---------------------------------------------------------- ------------------------------------ •--------------------------- ----- -------------------------- -------------------------- ------------ ---------- --------- -----._...-----•---- --------------------- FINAL INSPECTION BYbate - b - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 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.CD, J+ E