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'FOR OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- ---------_----------- (Complete in Duplicate) __________________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance'witii Count Ordinance,No. 549. E e-�_r ®�/9191_ S8 •� JOB ADDRESS AND LOCATIO�Vj �1 � �±>' � x1P ' - ----------------------------------- Owner's Name ---------- f ---------- Phone------------------------------------ AddressI _� ---- c• ----------- - ________ _ -------`�f -•--�-----•------- -•---------------•---- Contractor's Name ----- ---------�4___._ f r ------------------- ---•----- Phone.. _ _' ? Installation will serve: Residence 9, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _� Number of baths _fes_- _ Lot size - Lr---.._-/- /4f �__.--____________________ Water Supply: Public system (�$[ Community system E] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejV Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes W No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well_10M.f_Distance from foundation__��I________.Mater�l-____ __ _ _ _______ -----_------------- El No, of compartments------- -------------- ___ _Size_____ _ _ __Liquid de th____-__ -Ca acit 1t?7 _____ Disposal Field: Distance from nearest well JAW.-Distance from found _ Distance to nearest lotline_ __ �___ ❑ Number of I'snes_-..__- _________ ____ ____ Length of each li __ -1%G . idth of trench.___,______ � �` [� Type of filter material----- ;f Xr_ Length of filter m ---- --- ,-- - --- otal length-------- ---------------••--_- Seepage Pit: Distance to nearest well _____________--------Distance from foundation___•___ Distance to nearest lot line---__-________-._ ❑ {Number of pits----------------------Lining material----------.------------Size: Diameter--------- - ------ ----Dept h--------------------------------- Cesspool: Distance from nearest we}I-----------------Distance from foundation--------------------Lining material-------------------------------------- 1. ❑ Size: Diameter--------------------- ----------------Depth------------------------------------- ------Liquid Capacity----------------------------gals. —'Privy-- Distance'frorn�nearest well_________________________________________________Distance from nearest building------------------------------------ Dista nce ___________________________________Distance to nearest lot line----------- ------------------- ------------- ------------------------------------------------------------------------------- Remodeling and/or repairing (describe)__________________s _ f ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 , and rules and regulations of the San Joaquin Local Health District. r -----� (Owner and/or Contractor) (Signed) a_ r��___-4' -__ - _ _____ __________ BY:------ --- ---- ------------- =-- --- ----- ---------------------------------------------(Title)----- (Plot plan, showing size of lot, location of sysf i i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-=---------------- ------------------------------------------------------------------------------- DATE-------------------------------- --- - -- ---------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- ------------------ DATE------------------------------------------------------------ Alterations and/or recommendations--------------- --------___-------------------------------------------------------------------------•---------------------------------- -------------------- -------•---------------- ----------------------------------- ------------ --- ------- ---------------------------------------------------------------------------------•-----------------------• -------------------------- ---------- I � —46 G_FINAL INSPECTION BY-------- -------------------------- ------------- Date _- 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 REVISED 8-59 3M 3•'63 F.P.CC.