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FOR OFFICE USE: ------------------------------ ------------------ ------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. Z.�_7P.... --------------------------- -- - ------- ------ (Complete in Duplicate) ------- This Permit Expires I Year From Date Issued Date Issued _ _ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance_with County Ordinance No. 549. JOB ADDRESS AN , LOCATIONfC_� • Lv>.•••_. _ - -,,c _ - ------------ ----- --- .. Phone_-.- ------ -------------------- 1 Owner's Address. �,?.__.. - . _ --- = a -------------------- ---------- --•------------------------------ Contractor s Name-------- - ----_ _ ..... ___ ------- -------------------------------- Phone..--------------------------------- Installation ------ Installation will serve: Residence �Apartment House Commercial ❑ Trailer Court ❑ ��M//Diel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms �_ Number o baths _�ot size ------Y __ ±fir_________________________ Water Supply": Pub€ic system y ❑ Community system ❑ private Depth to Water Table -------- ft Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z-11'Clay ❑ Adobe ❑ Hardpan ❑ 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.) v� r Septic ank: Distance from nearest well--- ----------Distancte from f fundafion___--/0_- -_.-_,Material....--------------------------------------------- No. ___-_.___.__._-.________________.__..___.. � No. of compartments _.. 9__XS_'-.L;quid depth---- T r- ------Capacity--1 -a o- P �----- �--Size_ ----- Dispos leld: Distance from nearest well___.�:a-t__Distance from foundatyion----J-0 ---.-.Distance to nearest lot lin e,5 �._____-, Number of lines---.--- -_--_---______Length of each line--_(�-4__�_ Width of french --- _ Type of filter material------ Depth of filter material--- Tota€ length_-_.__v"rZ� d_____ - Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line--._-_----_.-__-i/7 ❑ Number of pits----------------------Lining material-----------------------Size. Diameter----------.------- ----.Depth---------------------------------T 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 + t t - � 1 Remodeling and/or repairing (describe):--------- ------ -•------------------------------� — - -----------------------------------------••------------------------------- -•- - ,F' 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 rules and regulations of the San Joaquin Local Health District. r (Signed) ------------------------------------------- :------- -_-,,-----fir and/or Contractor) or g �- Y� ------------------------------ -----------(Title)----------`---------------------------- ......... (Plot plan, showing size of lot, location of system in relation f wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-,-- � - DATE + - --------- REVIEWED BY r'il --- - ----- --------------------------- ------ --------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------=-------------- --------------------==----------------------------- DATE-------------•.. Alterations and/or recommendations:------ ----------- -- ----------------------------------------------------- . _ .... ' ----------------------------------------------- ------------------------------------------------------------------------------------------------------._--_--_..-----------_.___----_------.-_-----.-..---.--_--___-_-_-.._--.---_-----_-------------------------------------- ---------------- ----------------------------- _--.._--------------------------------------------- ----------------------------- ---------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------" ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------__----- FINAL INSPECTION BY:-- c .f/1--------------------- Date__ ..`/-7-_-----------------------_- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISCO 8-54 3M 3-'63 F,RCO. ..