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F R OFFICE USE: ay - - f ---- - ------ APPLICATION FOR SANITATION PERMIT Permit No. __...____•_._ .. - -------------------------------- ----------:--------- (Complete in Duplicate) - � pate Issued ..-.. ._�..�_.... ------------- _------ 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. f is made in compliance with County Ordinance No. 549. This application 1 `�I n 0 tZ!3 r JOS ADDRES 1 D LOCATION ------- �J� �Q Phone..... 42-�- Owner's Name-- - !/ Z Address---------Z----- 2 Contractor's Name ---------------•-`---------------------------------------------------------------------- Phone. Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court [I Motel �of1CNumber of living units: _.. .. Number of bedrooms ._ - Number of baths Lot size _.. .--.---...----------.. .... ._-------------.--_ Wafer Supply: Public system ❑ =-Community system ❑ Private�pth to Water Table 'bft. Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-----------,---------) No [ New Construction: Yes �d❑ FHA/VA: Yes 0 No [A� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Sewer is available within 200 feet.) Septic Ta Distance from nearest w -- Distant from f ndation_-TD.___...__.Material---- .- �gg,, ,g -0,r i No. of compartments... .. . . -Size__` .._ 'C_. �/.....Liquid depth_.. -.--.. Capacttyf. ....--. r Disposal Field: Distance from nearest well -----..Distance from foundation,-=�e----.._-...Distance to nearest lot IineJ.._.... r Number of lines._:�..�..____............._...Length of each line..�L�---------------------Width of trench..____ . ..�-..___-__.--......... Type of filter materia/ G .---------Depth of filter material--1 '- ----------Total length__..Ir4.:------._---__---.-:.. i See ge • - Distance to nearest well---- 4.t`.----------Distance i[om foundation--./__d..___..-..Distance to nearest lot line_—----------- Number of pits----c2 -----------Lining materialQ_.G-4-t-t.---Size: Diameter-_,: �?-- --------Dept h------ ----------- Cesspool: Distance from nearest well...--------------Distance from foundation--------------------Lining material..................-.._- ---------- ❑ Size: Diameter----------------------}--------------De th-------------------------------- ----Liquid Capacity gals. C Privy: Distance from nearest well-------------------------------------------------Disfance from nearer'+'building_.------------------------------------ o. _.........- .-__-------__-_.-- ❑, Distance to nearest lot line------------------ ---- --------------------- ------------------------- ------------------------------------------------------- Remodeling and/or repairing [describe)------------------------- ------------------------------- -----------------•---------------------------------••------------ --------------- ----------- --------------- - [� -----------•-------------------------------------------------------------------------------------------------- -----------------------------------------------I----------------------------------•--------.-----------------------------------•---------------•-•--------- 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 laws, and rules and re tions o he San Joaquin Local Health District. Signed( ) ------------------------------- (Owner and/or Contractor) ---------.-•-------• By-------------•------ ---- - ---- --------------------------------------------------------(Title)------------------------------ ------------ -------------------- (Plat plan, showing size.o cati system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `� -- -- �- -------------------- DATE �------------------------------------------ - REVIEWEDBY-------------------------------------------- ---- ------- --------------------------------------------- DATE= BUILDINGPERMIT 1SSUED----`-•------------------------------------=--------- - --------------- s----- DATE------------------------------------------------------------ Al#erations and/or recommendations: =f - �' ----- �-- ��-----fi-t-� - ------------ - •-------------•------- ---------------------------------------- --------•-----------------------------------•--- y -------------------------_._... ----- ---------------------------------....-----.---------------.-----------------------------'--------------------------------------'---------I------------------------ ------------------ I FINAL INSPECTION BY:------- -j'-------- 'z". gate 1 �1__% SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 31A 3-'63 F.P.EO.