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f �og oFFlcl: USE: / --------------------- �Q -3)--- ! � 1 APPLICATION FOR SANITATION PERMIT Permit No. .... 4_� --------------------------------------------------------- (Complete in Duplicate) / -------------------_.-_._..___.____._._._.__.__.____.__ This Permit Expires j Year From Date Issued Date Issued . 0q —31_ios 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. f D r�J r&i=llGK•_.41'► r JOB ADDRESS AND OCATIOt r-!`'""�"-�-- �DQ -------- Owner's Name.------ .4-cc_-- _ Phone------------------------•-•-------- -------------- ----------------------------------------------------------- Q. 3 -L Address .== --------- --•----------------------------- Contractor's Name :---------------------------------------------------------------••--•--- Phone-------------------------•--------- Installation will serve: Residence Apartment House ❑ Commercial-E] 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms __ _�Number•of-baths _ . ___ Lot size __, .��_ _______________f,__;______________.__-___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table gQ_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ San y Loam [] Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__________________ _1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 204 feet.) e r pti R: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- `V No. of compartments-- ------ --------- - Size---- _-------------------- ---Liquid depth-------------------------.Capacity----------------------- Disposal Field: Distance from nearest well Distance Distance from foundation__ZQ---------Distance to nearest lot Number of lines------------------ - --- Length of each line--- d `�------.Width of french-------v2.ear-__"___.___f.-•-- � Type of filter material_,S�- �- --Depth of filter material----f$---____-_Total length------------------------. �___-.__-- 1 Seepage Pit: Distance to nearest well_ , _- _:Distancef m fo __ ndation_ _01 __Q ._. ____ .DistanfDee to nearest lot line__�_6._______ Number of pits_____ ___________Lining material _ _F~ _..Size: Biometer___ 't - _Depth Distance from nearest well------------------Distance from foundation____.--------------Lining material_______ ❑ Size: Diameter----------------------------- ------Depth---------------- ------------- -------------------Liquid Capacity-------------------------•-gals. aJ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________.__._.__._. ❑ Distance to nearest lot lire-----------------------------------------------•--------------------------------------------------------------------•----------------------- F Remodeling and/or repairing (describe)_____________________ i ---------------•---•---------------------•-------------------------------------------------------- t ------------- --- -- ------ ---- - - --------•-------------• --------------------------------------------------------------- ►_ t ---------- r------------- ------------------------------•---------------------------------------------------------------------------------------------------------------•------------------------------------------------ I hereby ce 'l y that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+ e ws�anlru s and !gulaffions of the San Joaquin Local Health District. t (signed) ( ner and/or Contractor) BY '�`_"__--------- - ----------(Ti+le) --IF-------- ------- -- - --------- ---- -- (Plot plan, showing size of lot, location of system to relation to wells, buildi etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ --- -- �``-"�----------'-------------------------- DATE-------- rte' -- ---- ------------------ REVIEWEDBY---------------------------------------------'--------- ------ ------------------------------------------------------- DATE----------------- ----------------- BUILDING'PERMIT ISSUED----------------------------------------------I-------------------------------------------------- DATE-----------------------------------------=--- ---------•----- Alterationsand/or recommendations:--------------------------------- --------------------------------------------------------------------•-------------------•----------------------------------- -------------------------------------- --------•-----------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- -----•---------- -------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------------------------------------- FINAL INSPECTION BY:.----- f300 y`" -- - Date------�/ ------------------ ------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California alifornia Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.F.CO.