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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....................... ----------------------- ----------------------- / -- ------- -------------------------------------------- (Complete in Duplicate) Date Issued _f_�� --------------------------------------------------------- This Permit Expires 1 Year From Date Issued -C7Q-p t� l Application is hereby made to the San Joaquin Local Health District,for a permit to construct and install the work herein desc ed This application is made in compliance with County Ordinance No. 549. 1 a JOB ADDRESS LO ATION &1 4-441-y--Z,, ---�9,-�.Z------ t-:��,Z_____________ Owner's' Nam ------------------------ _ Phone--=--------------------- - Address -.w (K�( ----------- -----------------------•----------------------------------------- Contractor's Name -�- . --------------- Phone----------=---------------- - -._-___- ._______ P Installation will serve: Residence t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number,of living units: Number of bedroomsNumber '`Laths -_./_ Lot size -------- --------- Water Supply: Public system E] Community system [-] Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ y Previous Application Made: (if yes,date____________________} No ❑ New Construction: 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: t Distance from nearest well_______________Distance from foundation--------------------Material------------------------------------------.___-__. ❑ ; No. of compartments---------- --------- ---f Size---------------------------- ---Liquid clept--------------------------Capacity------------------ } Disposal ie Distance from nearest well---..S6-...-Distance from foundation_____ ___-Distance to nearest lot line----_�5___-______ +W Number of lines---------- _._ Length of each line--_-_L D-U---------------Width of trench._--- Type of filter material__ _ .t_-___ ----Depth of filter material____._��`______._Total length________l_!�_G._____________-____ Seepage Pit: 1' Distance to nearest well------------_---------Distance from foundation--------------------Distance to nearest lot line_______._________ ❑ # Number of pits-----------------------Lining material--------------------...Size: Diameter------------------.----Depth_------------------------------- �„l Cesspool: ,# Distance from nearest wet€-----------------Distance from foundation--------------------Lining material__._._________.____.____._________.__. ❑ ; Size: Diameter----------------------------------- Depth--------------------------------------------- ------Liquid Capacity----------------------------gal �. Privy, Distance to nearestlotlin€e____________________-___________------_- ____Distance from nearest building--------------------------------------- Distance g------------------------------ --- Remodeling and/or repairing (describe):-------- -------------- --------- --------------------------------------------------- ------------------------------------------------------------------- , a ---•---------------------------------------•------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------=---------- ------------- --------------------- -------------------------------------------------------------- A7 --------------"I-------'--------------------------------------------------------------------------•---•------------------------------------------------------------------------------------------.--------------___-__.... hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. C (Signed)''-`;----- - --------------- ----------------------------------------------- ----------------- wn d/or Contractor) ^- (BY=-=; --------------- ---------- - ------------------------- - (Plot plan;showing size of tat, location of system in .ratio, to wells, buildings, etc., can be placed on reverse side).49 f '.., FOR DEPARTMENT USE ONLY "--APPLICATION'ACCEPTED-BY- -._.. DATE- ' .- T -.. _. __ - --------------------------------- REVIEWEDBY-------------------------- ------------- ---- - ------------------ ------------ --------------------------------------------- DATE-------- ---•----------------------------------------------- BUILDING PERMIT ISSUED.--•---------------------------------------------------------------------k------------------------- DATE------------------------------------------------------------- -{ Alterations and/or recommend ations:----------¢=--- -`--------- - ----------=--=----`-t-----•k--------------------------- ------------------------------------------- ------------------------- --- ------------------------------------------------ ------. -------------- - ---------- ------------------------------ ---------------•---------------------------------------------•----------------------- ---------- --- ------ ---- ----- -------------------------------------------- ---- --------- - -----------------------------------------------------•--------------------- ------------------------------------------------ -- ------------------------------------------------------------------------- r 1 FINAL INSPECTION BY: ,z ------------- Date--- .�-- --�:---- T.-.--------- SAN_JOAQUIN LOCAL HEALTH DISTRICT X1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street slociilon,California Lodi,California Manteca,California Tracy,California f ES 9 REVISED 8-59 3M 3-'63 F.P.CO,