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FOR OFFICE USE: -------------------=--------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __116.6.yl_----- ----------------------------------I ------------ ----- - ------- --------------- ------------------- (Complete in Duplicate) ._Q.__. Date Issued _.- ------ -------------„__ _-----___-___- F' > This Permit Expires 1 Year From Date Issued I 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. ' r JOB` ADDRESS' Q=tOCY1Tl0 �4::'-"4 ---- _I '- -`- -------------- Phone-------------------------•------ Owner's Name-----�.....-- --t---- - --• -- - --------- ----------------•-- ------- -=------------------------ ---- Address-- l l --- - ----------- _---------- --------x , t ` phone Contractor's Name ---------- ----------- r .r Installation will serve: Residence Apartment House ❑ CC mmercial ❑ Trailer Court ❑ Motel ❑------------ Other ❑ Number of living units: _�_____ Number of bedrooms __�___ iVumber f baths -1----- Lot size ____-_____________________------ __________________ r Water Supply: Public system ❑ Community system ❑ 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 Con`fruction: Yes .❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool,permitted if public sewer is available within 200 feet.) Septic Tank: Distance,frcm•.nearest well_______________Distance from foundation--------------------Material----------------------..--____________,_________. ❑ No. of compartments--------- -!--------- ----Size---------------------=----------Liquid depth------------ ----------Capacity--------•-- ---- -•-- ^� Disposa:Field: Distance from nearest w II_.k_----- -Distance from foundation._-_M Distance to nearest lot line—'s Number of 'linesm:_: Length of each line_____-__ z `_ Width of trench.___ ! ___..____-_______ trench---- Type;of filter,materiai_�_c_ Depth of filter material____-__� __.-___Total le ngth_______ ;.c_____________ Seepage Pit: Distance16 nearest weli----------------------Distance from foundation________________-__.Distance to nearest lot Line_______________ ❑ Number of pits------ -----------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- •J 1 Cesspool: Distance from nearest weiL_-_._`_____:_Distance from foundation ___________________Lining [] ` ' material--._-__.___-____._._______________-__. Size: m __________ -Depth_---i------------------------------------------ - Liquid Capacity --------------------------gals. Privy: Distancefirarn nearest=well__-= -` "__.--- :.- y--------Distance from nearest building------'------------------------------- ___ - 0 Distance to nearest Ibt line="''a=: -- _`---- -------------------------------- ---`- -----1-------------------- ---------------------- - , Remodeling and/or repairing (describe):------ --------=----------------------------=-------------•------------------------------------------------------ 1 - _________________ ____`; ________________._,_________________--------------------------------------------.-----------------------.----------------------- ,/- _-__________________________________________�____._.________--_________ -A - ----- I hereby certify that I have repared this appii tion and that the work will be done in accordance with San Joaquin County ordinances, S lawsi and rule`and*r�ulations the Joa to Local k#ea4t r District. --------_----------------- i r and/or Contractor) {Signed)-------• ---- ---- -- ------ ---- --- t -------------------_-----------.----- ---------- (Plat plan. showi - size of -- --------- --- -- - -------------- - ---------'•- ------- - -----------(Title)--------- size of lot, locationyof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ _ ___ ___ __ __ __ __ _-- --------------------- ---------------------------------------- DATE.... ----------------------- -- REVIEWED BY------------------------------------------ - ----- ----------- ----------------------------------------- ------ DATE----------- ---------------------------------__------------ - - BUILDING PERMIT ISSUED - DATE -- - ----------------------- -- `--------•- � -------- Aiteretians and/or re -- commendations:------ ' ' = �--'- ---------------------------_------------------------------- -------------- -------- -------------------------------------------------------- -----------------•--------------- ----•- --- ----- ---- - - --- --- ------------------------•-------• --------------------------------- ---------- --------------------- FINAL INSPECTION BY-------------------------------------- -- --------------� bate--------------1_/--------- ----_/ ----------------- rr SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.CD.