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Y FOR OFF1ftSE• �'---- `" -- 7 APPLICATION FOR SANITATION PERMIT Permit No. .1. _. ?- --�J -------- ---------- -- ---------------------- -------------- (Complete in Duplicate) 7s . This Permit Ex ires 1 Year From Date Issued , flats Issued .__.;. ___... CCJ o ---v Application is hereby made to the San Joaquin Local Health District for a permit to construct and install worherein described. This application-is.rmade in complian waCofy Ord' new No. 544. , JOB ADDRESS A L C TION. f/ [.--� `••:-. [,t �`' ----------------------------------------------- Owner's --------• -• Phone----Name. . ---r ------- --�-- ---- ------ Address -•-- T Address.. �� •_.........{----- ..---•,_. - ---------•-----------------------•------................••••--...... - } Contractor's Name------------------ •---------------------_-----..----------. hon _ ....... `'. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ 'Trai r% ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms ._--.___ Number of bath ____-_-_ o size _.. _�Q-- - - ---•-•---------------•--- 1 Water Supply: Public system 8-11--Community system ❑ Private:❑ Depth to Waterlable -.00_ ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loa � m tlay ❑ Adobe[3 Hardpan --- ❑ �, Previous Application Made: (If yes,date -----------------} No Er---New Construction: Yes; o ❑ FHA/VA: Yes ❑ No ❑I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest weI4CGtdl± f_ fro found ion_/.4__._......M t ri I---------__---- Distance ` r �— �} ,� . p {� No. of compartments_____07-------------Size.. __ i - Liquid depth----- XX-.-____Capacity... .Q ?I Disposal Feld: Distance from near we,_ ___ __________ II I� Distance from foundation p _Q______.___Distance to nearest lot line .......____. Number of lines___._ ��.._ss__ __ Length of each line_____ -r- Yr__.__.Wid+h of trench----- ................0_.___ Type of filter materia __Depth of filter material_ --------- length-------------------,14.._...____ Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line__-___-_.._-.__.- Z ❑ Number of pits----------------------Lining material...-----------.--------Size: Diameter........................Depth----_---.-------._..•---------- Cesspool: Distance from nearest well---------------__Distance from foundation---------------------Lining material..........,------------------------ .- , . ��', ❑ Size: Diameter----•-•-•-=-•-------- •-------------Depth-------------------------------- - ---------------Liquid Capacity_...--------------...._.. g--_ als Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________----________-_---.--._______-. 0 Distance to nearest lot line------------------------------------------------------------ ' Remodeling and/or repairin {dascribe�:'___-----------------------•-------•---------.:....--- ---------- -- ; ------•••-•----•-•••-----•------------------ -- ------•-------------•---- g . - E ••-----------•----•---------------•--------------.----------_-----------------------------------------•-•-•---------------------'-_-------------------------------------------------•-----------.------------- I hereby c9rjfy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancer1laws, and les end re lations of the San Joaquin LocalHealth District. g norand/or Controctor1 (Signed)•- f - ----- -- F ---- ----• "•----- Title.-- �------------- - ---------------- BY:------------••-•---••----------------------••.........------------ -----•-------------- - ) (Plot plan, showing size of lot, location of system elation to well uildings, etc., can be placed on reverse side]. OR DE RTMENT USE ONLY APPLICATION ACCEPTED BY-- n•�-- --------------... DATE---------2!-__-__ .�----------------- REVIEWEDBY.....-.. DATE-------------------------------------•-•-....--• -•-------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- •---------------- DATE-.-----------------------_-_.-------------------•--•---- jAlterations and/or recommendations:...----------------------------------------------------------------------------------- ----------------------------------------------------------------------- -----•- ---------------------------- -•-••---•-•---•-----... --------------•--••------------- { ---------------------------•--------------------•------------------------------•--------------------------•---•------------------------ t a . FINAL INSPECTION BY:-----.0----- ------------ -------------- Date__... '{. -•- ----•---------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Callfornla Tracy,California E6 9 REVISED 9-59 $M 0-61 Ai LAB k