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FOR OFFICE USE- e ------ ----- --------------------- ---- APPLICATION FOR SANITATION PERMIT ' ' }`,Permit No. _Z722..1�...i ----------------- - ---------------- ----- (Complete in Duplicate) Date Issued .____-.f�_ __��`f -----------------_------_-------------------------------- This Permit Expires S Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. Thi a.p licationTis made7ipliance with County Ordinance No. 549.' JOBDDRESS AN(D 1_O ATION_ 1.-.- - ----- .. ------!' t Owner's Name--------------= ---- -- ------- -- Phone---------_----------------------- Address -------------- ---------------------•----•--------------------------••-----------------------•------•---------••-------------------. ....---- Contractar's Name.- ' / CII/1. --------------------------- --------------•---•---------- •------ Phone------------------------._._..----. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ____________________________________________________________ Water Supply: Public:system ❑ Community system •❑ Private ❑ Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: IIf yes,date---------------------I !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.) 4 Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material--------_----------------------.----------------. ❑ No. of compartments------------- --------- Size------- ------Liquid depth----------------- --------Capacity----------------------- Disposal Field: Distance from nearest well----------------Distance from foundation--------------------Distance to nearest lot line______________-__ ' ❑ Number of lines---------------------------------7 Length of each line------------------------------Width of trench------------------------------------ Type of filter material-------------------------Depth.of,filter_material------------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well-----f---------------Distance from foundation--------.-----------Distance to nearest lot line______________._. ❑ Number of pits--------------------'_Lining material______________74-----Size: Diameter-----------------------Depth-----------------------.__-______ Cesspool: Distance from nearest well--------------�_Distance from foundation-----------::-------Lining material------------------- Q ❑ Size: Diameter------------- -------------------Depth? = Liquid Capacity oaks. .Distance from nearesf.building ------------�----�---- J Privy: Distance from nearest well--�------------$ = ----- _-- =- ------------. � - - - --- � El Distance to nearest lot line-=----"- -- -------------------------------------------------------- - ---- Remodeling and/or repairing (describe):_____ — "" - -------- •---••-•--------- ---------------------------------------- ------------------•----------------•----^------------------------------------------------------------------------------ - --- - - - --------=----------------=---•---------------------------------.._..; = -----------------------•------------•-----------•-----•--------------------------------------- ----------------------------------------------------- ----------------------•---------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, St a ws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------ -------- �,--- --- (Owner and/or Contractor) •..». �.. : --:-�`� ------- - ----- --{Title]-- =- -- -- �..._...:- T -• --- (Plot plan, showing size of:Iot, location o. ..system, in relation to ells, buildings, etc., can be placed on reverse side). I .- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE S ------- y---------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------- ------ �l BUILDINGPERMIT ISSUED------------------------------------------- -------------------------------=------------------------- DATE--_----------------------- ---•-- Alterations and/or recommendations--- -------------------------- --------•---------------------------•-----------------------._._-.----------------------•---------•------------------------• l --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ - - - -------- ------ -------- .-------------------•------ - Y-i' ' -( ----------------------------------------------- FINALI INSPECTION BY: ........ .......... -------- bate 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 E5 9 REVISED B-59 3M 3-•63 F.R.CO. -