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-- - .YrFOR OFFICE rUSE: _�.�--�- .......� 1 APPLICATION FOR 'SANITATION PERMIT Permit No. .............. . ---- ---- - --- - �sdf J (Complete in ,Du licate) r Date �sued -------------- -------------------------------------- This Permit Expires 1 Year From 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 compliance with County Ordinanc No. 549. JOB ADDRESS ANDCATION---- ZP ---- ---- - --- ------------------------------------------- -------------- ------------------------------------- Owner's Name_- Z' Phony -^-, ---------—- ------- -- Address------- ------------- -------------- ------ s � Contractor's Name--- =------------------------------------ ----------------------------------------- Phone--------------•-----• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ c Number of living units:.--/-- Number of bedrooms.9_ Number of baths pt--- o-- Lot size _ ! _ ______-_______-________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _45rr t#. Character of soil to a depth of 3 feet: •Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe 2-Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes ❑ No RR�FHA/VA: Yes- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - SeT nkw' t Distance from nearest well-----------------Distance from foundation--------------------Material____-___ ------_____-----______-.--_________- fi-1 No. of compartments--- ------------ -------Size--------------------------------Liquid depth---------- ----- ----------Capacity--•-------------------- DisposalrFielclx ' Distance from nearest well---------------_r Distance from foundation--------------------Distance to nearest lot line----------------- IPI/7/01 Number of lines-----------------------------------Length of each line-----------------------_-----.Width of trench--------------.--------------------- Jr Type of filter material_________________________Depth of filter material_-______________-______Total length------------------------------------------ 6` r f / / O Seepage Pit: Distance to nearest well___-----_ ________Distance f Mn fo ndation--r��___.Di to c to nearest of line � Number of pits__________-___-_-Lining material/,AG_�C-----Size: Diameter_`_-__.____Depth Jam_ Cesspool:' Distance`-=from nearest well---------------- Distancekfrom foundation--------------------Lining material_-_______---_____________----____-__. ❑�k ' + •� Size:, Diameter--------'-----------------------------Depth-1------==--------= ------t--------`----------Liquid Capacity...---------------------`--gals, Privy --�. ¢.Distance from nearest;uieil_____________________________________---:- __..Distance,from nearest building------------------ ------ ❑ .c. r ---- ----------------------------------------------------------------- -------------- -------- --- - Y:Dssta�ce to nearest lot line__--_-___ `� $ Remodeling and/or repairing (describe):--------�� --- --- - - --------------- - -----+--Z--- --- --•-----------------------------------------. a ------------------------- ----------------•----------------- ----------------------------- ---------- ----- y-------- --- ---------------•---- •----------------------- -----------------------'-------------------------------•---------j-----•--• --- -----•-•----___-_______._- -----/� _ f�; c+ � of.d� rr!y • vZ Sf (jfj t ------ --- ----- --- ---- 1 hereby certify that I have prepared this application and that thorki been n accordanceth'San Ja�q m ounty ordinances. 7afe laws, an rules and regu tions of the San Joaquin local Health District. e * (Signed) t - r Contractor) JI ----- ------------ BY: ---e--------(Title) - - ---`---------------- i (Plot plan, showing size of lot, location of system.in) tion to.wells,.buildings, etc., can.be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------- C -------------------------------------------------- ------- DATE----- ~ �/ ' `�' ---------- ------------ REVIEWEDBY------------------------------------------ -------------------------------------------------------------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED ------------------------ DATE ----------------------------- - I Alterations a J r recomme^datio s:- - - ------=-- ------ --------------------- ---•--------- ---------- •--- --------------------------------------------- --Lj!' { ------ - ----------------------------------------------------- ---------- -- -•-- -•--- -- --- ---------- r. - ----- ---- . - --- ---- ----- l .. ' ------------ ~ .r --- - --- ,---- - --- _ - -o- �� .G� `� Fav cr FINAL INSPECTION BY------------- --------------------------------------- Date.... ---------------------------------------------- SAN --------------------------- - ---------------SAN JOAQUIN LOCAII--ALT DISTRICT 1601 E.Ftazeltan Ave- 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Callfornla Lodi,California Manteca,California Tracy,California VS 9 REVISED 8-59 3M 3-'63 F.F,CC. k f