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FOR OFFICE USE: ----- ----------- - --------- ------------ ------------- � l APPLICATION- FOR-SANITATION PERMIT Permit No. ...... .......3......... ----------------------- ------------------------------ (Complete in Duplicate) /J J6 5 This Permit Expires 1 Year From Date Issued Date Issued __________________ ___ L ( -- 6SO--v 2— Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor ereln escri6ed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA N - ��? Zle,_441 Owner's Name _ - Phone------------------- - C -•--- 1 h. ------.-Address - . Contractor's Name---- - �---- -------- ----••------ one----------------------------------- Installation -------•---••-•--•------ -------Installation will serve: Residence Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] .,....Number of living units:.,__A umber of bedrooms __Number of baths -_/__ Lot size . a___,e�_I _____________________________ Water Supply: Public system Community sys em ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date-----------------___) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 1 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-------------------------_---_-___-_-._.________. ❑ No. of compartments--------------------------Size----------------------------__Liquid depth------------ -----------.-Capacity_-•-----•-------------- Dispos Field: Distance from nearest well___._. —___-Distance from foundation�rl.L-_____Distance to neareslot)ne_____�r_._ ..._ Number of lines-----------�_____� ------Length of each line----- --? -.___--------.Width of trench-------------------------------- Type --�---------------Type of filter material-----.?_I,-0------Depth of filter material_.___L,�__�f____Total length_________��___________�-___,____ ZDistance to nearest welL___�GC�-------_Distance from foundation------ ' ___=.Distance to nearest lof line----- --------- Number of pits________ __________Lining material_._,S�o_______.Size:-fir_.3_i _7.4_Depth----�3 • 1 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_:_.____.____._____________________-_. ` ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.,_.____________________________.__:, , ❑ Distance to nearest lot line.-- - ------------------- -----------------•------------------------------------------------------------ -------------------------------,: Remodeling and/or repairing (describe)=------- ---� ZI �--- - ---•--------•---•---------------------•-----------------------•-------•----L . ------------ -- - ----------- •------- ----------------------------------------------- -- i I hereby certi"hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SLllawsss,��and rules and regulations of the San Joaquinlocal Health District. (Signed)---------- ----- ------- Fin -- - -------------------------------- ------ /or Contractor BY: -�'- - ----------------------------(Title)-------------------------------------- --- - ---- -- ---- (Plot plan, shoof lot, location of systlation to w Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- i7► -- 7.DATE____/ _ 'G r_______________________��__ ------------------------------------- - REVIEWED BY----------------------------------------------------------------------------------------------------------------- ----------- DATE-------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------— -- -------------------- ------------- DATE---------- ------------------------------- ------------------ Alteratio4sand/or recommendations-------- ------ ----------- ---------- ----------------------------------------------------------------------------------------------------------•---------.- ------------------•----------------------------------------------------------------------------------------------------------------------•-------------------------------•-------------------------------------------------- p O` Date +6_-4s ------------------------------- FINAL INSPECTION BY:- f ------.---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street Stockton,California Lodi,California 'Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. -