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FOR OFFICE USE: -� ---------------- ---- ------ -- --------- --------- APPLICATION`FOR-SANITATION PERMIT Permit No. ...... .. ----- ------------ ------ (Complete in Duplicate) �.. _-------- : Date Issued __!_1._3-413 This Permit Ex fires 1 Year From Date Issued b 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 CATION-- ---_- � --- ------------------------------------- ----------------------------------------••-•--• ------------ Owner's Name -�i..� :? v- - -------------- -- --------------v------------------------------------ Phone .-----------•----------••--j•--�-- ---- � Address------ --------- --------------------•-------------------•----- -Can#rectors Name • Phone ;75. ------------- --- Installation will serve: Residence E�`Apartment House ❑ -Commercial-E] Trailer Court ❑ Motel ❑ Other E] I Number of living units: - -- Number of bedrooms -Number of baths __r_-- Lot size ____do�Q_-- - ---_--_--__--.--. ` Water Supply: Public system Community system E] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sand _Loam [] Clay Loam ❑ Clay ❑ Adobe ardpan [] Previous Application Made: (If yes,date --------------------) No E New Construction: Yes ❑ No �HA/VA: Yes ❑ No W4—' + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_-----------------Material________________--_____- 1771 No. of compartments--------•-----------------Size------------------------------ Liquid depth-------------------------- - r Disposal Field: Distance from nearest well-----------------Distance from foundation----------- ---------Distance to nearest lot line______________-. ❑ Number of lines_'---------------------------------°Length of each line---------:-------------_-- ' ----Width of french. Type of filter material-------------------------Dept.h of filter material-----------------------Total length-------------•---:------------------_----- rn Seepage Pit Disfance to neareswell__ Distance from foundation_ _ _'_Distance �e to nearest lot line-45 --- 1 i Number of pits_ ___ -__------------_Lining material_e�- ef=_Size: Diameter___ ....______.Deptn_ .I_ _/? ----• r Cesspool: Distance from nearest well-----------------Distance from foundation--------------:-----Lining❑ material--.____-_.___,____-_____._ ---- a l Size: Diameter---=---------------------------------Depth---------------------- --------------------- ----Liqui.d Capacity---------•----------=-------gas. d ; Privy: -Distance,from-nearest well----------------------------------- ____--_Distance from.nearest building_--__..__-____________________._ ❑ Distance to nearest lot line----------------------------------------- Remo deling ---------------------------------------Remodeling and/or repairing (describe)___________________ ` _ I -------------------------------------------------------------------------------------- ---------- ---------------------------------------------------------z---------------------I---------------------------- :._ --------------------------•-----------------------------------------------------------------------------------------------------------------=------------------------------- I hereby certify that I,have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , nd rules and re ulations.of the San Joaquin Local Health District. (Signed) i-------------`----------------------------------------------------------------------- ----(Owner and/or Contractor) By--------------------------- ----- (Title)-- (Plot Title __ (Plot plan, showing sizg oFlot, location of. system,in relation to wells,buildings, etc.,.can be placed on.reverse side}. f/ { FOR DEPARTMENT USE ONLY APP1 ICATiON ACCEPTED BY - r -��GtJ--------------- ------------------------- DATE------- REVIEWED BY--------------------------------------- d -------- -------------------------`---- -_----------------- --------------------•--- DATE----- ------------------------------------- BUILDING PERMIT ISSUED DATE-------------------------- -------------- ------------------------------ -- Alterations and/or recommendations:-___-.._---_._______________ - -----------� "` ------------ / � ----------------------------------------------------•----•------------------••-- -•- - -------- �T-c. -------`--� b_,�_ _-lc�3.__.__-Lrrxc . R__ - _------/--- ---------- ----16� ztt� _ `yam FINAL INSPECTION BY:.. ---- -� ----------------- -------- Date-- --------- d" SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffaxelton Ave. 300 West Oak Street 124 Sycamore Street �� 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVtr ED B-59 3M 3-'63 F.P.CC. - f.