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FOR OFFICE USE:-" x ----- -/r.- ---------------------5_-- - - APPLICATION FOR SANITATION PERMIT Permit No. ..1 Y.....�1 (Complete in Duplicate) / (f Date issued 1.. / _7 ____________ _ ______________________ 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 Ordi nce No. 549. ' k JOBADDRESS AND L CATION..- -°� ---- - - --------------- ------------------------------------------------------------------------ ---------------- / -- . ---------- Owner's Name d i- -- ------- ----------- - --- ---- ------- ---------------- Phone------------------------------------ Address ---•-------------i------- 8r Contractor's Name --- -------- ---•-----•••---------------- ------------•---- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �D Number of living units: ____J__ Number of bedrooms __3_- Number of baths -------- tot size .___/_--_.-______�___._.______.________.__.__________ Water Supply: Public system�ommuriity system ❑ Private ❑ Depth to Water Table _-6_ ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ . Adobe [�Rardpan ❑ Previous Application Made: llfyes,date---------------.-___) No New Construction: Yes 2"�o ❑ FHA/VA: Yes ❑ No K_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available'within 200 feet.) Septic Tank: Distance from nearest wells-f!0——--_-____Distance from foundation---A----------Mate _ rsal_______�___-..�_________ _______________ ______. ` • No. of compartments_______-____________Size----3x,_ X__�__Liquid depth-__.�__________________Capacity____ --- O r / Disposal field: Distance from nearest well____._._.Distance from foundation..l ____ _______Distance to nearest lot line--- Number of lines-----2------------------ -7 -______--_---._.Width of trench.s�.`. __-! -----Length of each line--------��r �--------------------- r .� Type of filter materia�W.-_Z_< of filter material__- Total-length_ 3 ______________________ W Seep Pit: Distance to neareS welL___________________Distanc om foundation_._ a_..-._._Distance to nearest lot line_V__/_-_ x Number of pits...... Lining material �.L -- -Size: Diameter---aj__ - --Depth--,.. - ---------------------- Cesspool: _----------------Cesspool: Distance from nearest wel!_________________Distance from foundation------------_"` __.Lining material.------.-._________.______________.__.El N Size: Diameter--------------------------------------De th-------------------------------------------- ---Li uid Ca acitgals, %A Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-____--._------------_________-'._____._-. , ❑ Distance to nearest lot line------------------------------------------------•-------------------------•---------- G : Remodeling and/or repairing (describe)---------------- ----------------- --------------------•-•-••---------------------•---•----------•-------------------------------------------------------- .O -- - ------------------------------------------------------------------------------------------ -----------------------------------------------------•------------------•-------------------------------- ----------------------------•----------•---------------------------------------------------------------- I hereby certify that I have prepared thippon nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulafJoaquin Local Health District. Sined 9 )---------------------- -------- --------------------------------------------•----------------------------(Owner and/or Contractor]BY:-------------------------------- --- ------- ------- ------------- -------(Title)--------------------- ---- (Piot plan, showing size of lot, at' 0 s to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -- " APPLICATION ACCEPTED BY_...0. • _%V kms------- -'--------------------------------------------------------- DATE----- REVIEWED BY----------------------------------------- ------------ - - ----- -----------------------------------------------------------. DATE------------------------------------------------------ - - - BUILDING PERMIT ISSUED----------------------------------- -------------s -------------- ------------------ DATE---------------------- -- ------- - ------------------- - ------ Alterations and/or recommendations:----h-to....(p__ ---------I---------- __ -------- t__ ___•- .......... -------------- --------------------------------------------- - - - - --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ------ ------------------------------------------ ---------- ----------------------------------- ---------- ---------------------------------------------------------------•------------- FINAL INSPECTION --------------------'-------------- 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 V REVISED 8•59 3M 3••G21 F.P.CD.