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FOR OFFICE USt: --------------------------------------------------------- ----- ----_-----_-------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- - w. (Complete in Duplicate) _ ------------------- This Permit Expires 1 Year Froin Date Issued Date Issued Application is hereby made to the San Joaquin Local"Health'District for a permit f construct and install the wo-rlyherein described. This application is made in compliance with County Ordina e . 549. // yp JOB ADDRESS TION_ --- -.1�- �----- -- - Owner's Name__ -C��------------------ - ---- Phone-=--•-----------------••------------ Address. t — ' � -------------------------------------------------------- •--•---- °--- -- Contractor's Name---�- -- - ---• --------- �"-----� - -----'-- ��--t_ —-------------------------------- Phone-4146--,3�t- Installation will serve: Residence 940'oAparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ --- --- E Number of living units: __ ____ umber of bedrooms Number of baths -1____ Lot size ___ 0 ________________"- Water Supply: Public system ommunify system ❑ P,rivate❑ Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: I Sand ❑. Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date........._,------- No ❑ New Construction: Yes W No ❑ pHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # L ----- (No septic tank or cesspool per i#public ewer is available within`200 fee},) #, r Septic Tank- Distance from nearest well Distance fro WOU .—Tinquid o ___ ___ __________ terial-_047t-,��_____ _____________ _ No. of compartments__-- Size de th -- -__________:Ca acitP� P Y Disposal Field: Distance from near st well. '. __.__ _..._Distance from foundation _.L�.___. pistance to nearest li e . Number of lines____ ____Length of each line Width of trench____' .......... ` . _.__S _ _ __ _ ________ _ _ _Type of fi#ter mat p �_ g �-- _De th of filter material___________ __ _ �otal len th__.__.---_._____-_______ ______ Seepage Pit: Distance tomearest.well__---------- --------Distance from foundation--------------------Distance to nearest lot line------ ---------- 0 El Number'of pits----------------------Lining material------ ,---- ---------Size: Diameter------------------------Depth------------------------------------------------------ Cesspool. Distances from nearest well-----------------Distance from foundation.__---------------- Lining material-------------------------- Size: Diameter----------------------------- - Depth------ ° - - - --_-- ------=- -- ------Liquid.Capacity-------------------------..gals. -- �- - _-=� - Privy: Distance from nearest we13____________,_____ _ _ ____________________,Distance from nearest build._----- __________________--_._.___.._. 1 ❑ Distance to nearest lot Iine---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):_-__________________ s. ----- -------• , •--=--__.--•-------------------------- --------------------------- -- ----------------------I----•--------------------------_--•------------------------------------------------------------ --------------------------------------------------- i f r,y:I + r ---------------------------------------------- ------------------------------------------------------------------------------------------ ----------------------------------------- ------------------------- I hereby certify that (have prepared fKis'applicatian an at the work will-4Fie Aone'in accordance with San Joaquin County ordinances a la d r and re ulatto of the Sa oaquin Local,Health District. 3 Si ne ------- -- ; r,t . ---- Title ----------------------=----=---------------- '------' (Plot plan, showirtg.size of lot, -location of systern`in relation to , buildings, c.,-can be placed on reverse side]. � t ` FOR DEPARTMENT U31~-QNLY APPLICATION ACCEPTED BY-------1 7R -0 ---------------------- -- ---------------------------------- ' DATE--- Q`_I` s REVIEWED BY-------------------------------------=---------------------------------------------------------- -------- -------------------- DATE------- f BUILDING PERMIT ISSUED---------------- ----•------------ - ----- DATE -------------------------------------------------- Alterations and/or recommendations=----------------- ----------------------------------------------------- ----------------------- -------------- t 4 k ----------________-------------________________.___.__..._ -------- __________-----_-_-_.._-.___..___.----_.__._________________.___._______.__._'____.________-__._________-_._.._-___- E i s• -----------------------_______________________-...__.------ _ _ _____ _-_ __ _ __ _ ___._. ...................___..._._._..______. ____._......._ __ ..... ---------------- __ _ ---------------------------------------------_ ..__________ -.____-._.___-L ____...__.___ _.-_____ -__ FINAL INSPECTION BY:. '- - Gly:/- ----- ---- - -- - ------ Date - 1. Lam._ - - - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` ` � r 1601 E.Hoxelton Ave. 300 West Oak Street " l24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED S-59 3M 3"'63 F.P.CD.