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r !KUrrlC,t USt: —� _ .' 3 _ N r- �"c APPLICATION FOR SANITATION PERMIT Permit No. /.•.:�_7. � ' (Complete in Duplicate) ---------------- -- --------------------------- --,--- This Permit Expires 1 Year From Date Issued Date Issued --7""«_,7. 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 No 549. JOB ADDRESS AND LOCATION..--___-1."Q-_ " 4 2 ----- Owner's Name-- _- --- • ..... --- -------------------------------------------- -- ------ Phone------------------------------------ -- Address ----------- ---- ?Q Contractor's Name-------------------- L�G 4 q/Q r� ----"- ---- ----- Phone-------•---• --• -- H ! Installation will serve: Residence X Apartment House ❑ Commercial--El Trailer Court ❑ Motel ❑ Other ❑ !Number of living units: � Number of bedrooms __/__ Number of baths _/__ Lot size _,��";�l -----------------------------0 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4V- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: (If yes,dote--------"---"- ---) 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.) *Sflt .ank: Distance from nearest well---------------_-Distance from foundation-------------------Material No. of compartments---------- ----------- ---Size--------------------------------Liquid depth----------------- --------Capacity I Distance from nearest well. ---- Distance from foundation------- ------.------Distance to nearest lot line----------------- Number t lines---- ria!----_"-------------------Length of each line------------------------------Width of trench------------------------------------ ype of filter material-___--------------------Depth of filter material--------------------.--Total length------------------------------------------ Seepage Pit: Distance to nearest eIj__ _-Distance o fo ndafion 1 -_-_--.pistance to nearest lot line--_-5-----• Number of pits----- _----___--Lining material-_��-.Size: Diameter---_ - --------Depth------ �-`-�--!----------- C?"PE-ol: Distance from nearest well---------- -----Distance from foundation--'-. ._---.---_".--.Lining material------------------------- _- e El Size: Marrleter-------------------------- ------ ----Depth----------------- -----•--------------- -----------Liquid Capacity-- --------- -----gals. Privy: Distance from nearest well_--------------------------------------------.-_Distance from nearest buildin In ❑ Distance to nearest lot line...... Remodeling and/or repairing (describe):__----------------___----------------------------------------------- --•----------------•---------•---------------------------------•------------------------------------------•---------------------------------------------------------- •------------- --------------- --- -------------------------------------------------- -----N I here ce if that I have prepared this application and that the work will be done in accordance with San Joaquin County5. "ordinanc t e laws, an rules and regulations of the San Joaquin Local Health District. (Signed! ------------ / Contractor) ------ ----------- - Owner and/or By: ------------------------------- -------------(Title) (Plot plan, showing size of lot, location of sys em in relaf' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- .-�.c --------------------------- -------------------------- DATE--------------------------- -a2-- - --- - - -� " ------------------------ REVIEWED BY ------------------------------------------------------- DATE------ ----- ------ BUILDING PERMIT ISSUED------------------------------------------- ------------------------- DATE--------- Alterations and/or regommendations-- ------------ - - —--------------------- C- • •------------------------------ •------------------------------------------------------------------ -- cam., _ _-:--- -- ---- ------ - -- --- - --- ---- -- -- --- -.� � ---------------- a 4 _ -- FINAL INSPECTION BY:. - --- - ------------ ------------------- Date------------77-a '7-6.� 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 GEVISED 8-59 3M 3•163 r,p,po.