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FOR OFFICE USE: ------ �Y -------------------- - APPLICATION FOR SANITATION PERMIT Permit No. _44---f.......... ----------------------------------------- ------- --- (Complete in Duplicate] Date Issued .----- .� � - ------:--- , I - - This Permit Expires 1 Year From Date Issued --- -------------: --------- ------------ ------------ - b(,.Fr Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her ' escribaed. This application is made•in-compliance with County Ordinance No. 549. I {J -_JOB DDRESS LOCATION_ l ,_ f�`t 3 --------1 net '-- Z� Owner's Na - ,.�'=1 Phone. Address--------• - - T-----------------------------------------------------------r Contractor's Name------ '----- - Phone... .._.... a !t Installa+ion will serve: Residence Aparfinent House ❑ C mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F y / Lot size _--41-0 - --••-- --- Water Supply: Public:system ❑ Community system ❑ Private Depth to Water Table _ f#. , Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous-Application Made: (If;" es,datEj e.... ..............I No ❑ New Construction: Yes ❑ No [� FHA/VA: Yes ❑ No TYRESOF,INSTALLATION AND SPECIFICATIONS: (No septic tank or*cesspool permitted if public sewer is available within 200 feet.) est well______________.-Distance from foundation-- ----------------- Mater•sal---------------------------------- _ - .-.---}--_. Septic Tank: CD tance Gm nea ❑ No. ofkcompartments-------------- -----------Size------••------- ----------------Liquid depth--------------------------Capacity------ ----------------- W Disposal-Field: -_D stance.}from nearest wellDistance from foundation__-.._---_-_-_-._.-Distance to nearest lot line----------------- 11y ❑ Number of lines------I-----------------------------Length of each line---------------------------- Width of trench. Type of filter material-------------------------Depth of filter material----------------------.Total length-------------------------------•---�---- Seepa Pit: DiOancelto nearest well___ ____Distance fr m oundatian___�_'t' _�_.___D'is n oto nearest lot line ___-___._ k p _--___�__Lining mater Diameter._..__ _-______.Depth� ...�__----------------- Q Number' of its----- _- Cesspool: Distance from nearest\well-.-__-__-----_-_Dis#ante from foundation__________________.Lining material__..__._._..________-_______________ 'Size:'Diarneter----------- 7 Ir ---------------------------Depth------ ------------------------------------------...Liquid Capacity gals. Privy: Distance from nearestewell--------------------------------------------------Distance from nearest building----_--__._,-_----___________..--__-�!` ❑ Distence,ta„nearest lot line------------------ ------------------- --------------------------------------------------------------------- Remodeling and/or,.repairing (describe):--.------°---------------- ---------•----------------------------------------------------------••-------------•-•----------------------•• ['f ----------- - Epi -------------------------------------------------------------- '� h __________________________ ___________________ ____ ___________________________________________ ___________________________________________________________________________ .. .___ ' •� 'ff __________________________ ________ _____________________________________________________________________________________________________________________ I ---------------------------------- -- ----------------------- �- I hereby ce ' y hat l have prepared this application and`�hat the work will be done in accordance with San Joaq�niCourify ordinances, Sta w , and rules and regulatia the.,San.-Joaquin Local Health District, (Signed) -- '--------------- — -------- - or Contractor) gY . - -----------(Title)--------------------------: -- ------- -- - -------------- (Plot plan, owing.size of I. location of sys+ in rely+ion wells, buildings, eEC., can b6 placed on reverse side]. FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY-_- - --- --------------------------- --- DATE REVIEWEDBY-.-- _------------ ------------------- -- ----------------------- -------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------ ) 6ATE------------------------------------------------------------- Alterations and/or recommendations:_..----------- ----- ( ---i----•-------•----•----------•-----------------•--------------------- ----------------------------------------- ----------- ---1_-------------------------------------------------------•----- ----•--------------•---------- ------------------------------------ -------------------------------------------------------------------- -------------------------------- -------------- ----- -------------- ----------------- ------- ------------ ------------------------I---------------------- ------ ----- -------- --------------------------------- -- -------------------- FINAL INSPECTION BY: �r -------------------- Date. .�. ” r" 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 ES 9 REVISED 9.59 3M 3-'63 F,P.CD.