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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ... ... --------------------- ----- . (Complete in Duplicate) Date Issued . 4 46 3 ---------------------- ------------------ -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 9. - ---------------- _7 .JOB ADDRESS AND OCATION-------��J----�---�---�`------- --- ---------------------------------- ---- ----------------------• -- -•- - --- --- r r Owner's Name_--- . --------- Phone Address-------------------------------- --�'�' ------------ - ;�- 1 -- Contractor's Name = = ------------------------- Phoned. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /-_-- Number of bedrooms . ®® 6 P-----. Number of baths _/-. Lot size _---- 5— '�.Z_s-._.._..-........_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 41'oft. i 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 El No FHA/VA: Yes F] No E] TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p ' an :_ Distance from nearest well-----------------Distance from foundation---------.----------Material------_ ------------------------------. No, of compartments--------------------------Size..-- -------------Liquid depth--------------------------Capacity------------=---------- r Di0spos I Id: Distance from nearest well .Distance from foundation.. �C?-------.Distance to nearest lot line................. t rt Number of lines---------- __._.-_.- Length of each line.............�..�__.__...Width of trench-___�_�-.--......--i_...... Type of filter materiaL�---.Depth of filter material___-. ,�T_f.�....Total length....................10 �1.__....__.. Se epa e Pit: Distance to nearest well=._-_Distance rom f ndation./.C?.____._.. Distanco nearest lot line------- el Number of its--------/-------------Linin material-.� 3_3------ P *� P ( g ��,!!! Size: Diameter--- .De Depth r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.-------.---------------------- ❑ ' Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------.-_.------------------------.---- cp ❑ Distance to nearest lot line------------------------- --------------------------------------------------------__-------------------------------•-------------------- G r Remodeling and/or repairing (describe):-------------------- - ----------------------------- ---------------•---•------------------ ---------------------•----------------------------..------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ... S/ --------------------- --------------------------•------------------------------------------------------------------------------------------•------------------------------------------------------------------------------- -----------------------------•-----------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S,g feaws, and rules and regulations of the San Joaquin Local Health District. , (Signed)-----1- -------- ------------------------------------- (Owner and/or Contractor) By:--------------------------------- -------------- � ----- (Titlel - -1---------------- - - (Plot plan, showing size of to+, location of system in relationwto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ` -5--------------------------------- DATE r//��1---3--------------- REVIEWEDBY-------------------------------------------- ---------------- --- ------------------------------------------------------- DATE------- ---------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ---------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations--------------- --- --- -- --------------------------------------------------------------------•-----------_------------- ----------------- ---•-------------------------------------------------------••-------------------------- ----------- -- ------------------•--------------------------------------• ---------------------------------------------------------- ------------------------------------------------------------------------------------ ---------- -------------------------------------------------------------------------------------------------------------------------- -------•--•-------------------------------------------------------------------------------------------- ---------------------.-------------------------------------------------------------------------------------- ------- -----------------------------•------------------ --- ---------------- ------------------------------------------------- ----------•------•--------------------------- ------------- ----------------------- 7'- FINAL INSPECTION BY:.-- � 1- �--- ------- - -------- ------- - Date---i- -r -------------------------------------------- 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.CII. - r--