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FOR OFFICE USE: -------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 1077------------------------------------------ .. ------ --- ------ (Complete in Duplicate) ' ._From Date Issued Date Issued ------------ ------------------------- DS'(—/c/v Z3 -- This Permit Expires � Year F 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. 3�- /✓...a t JOB ADDRESS - OCATION Owner's N -- ----••----•------ -- ----- - Phone - Address ---- , - = r-- x Contractor's Name----------- - )�• 1�7---- --- ��--cii -- Phone.------- ------ -- ------------------ ---------- --------------- ------------------- Installation will serve: Residence W Apartment House ❑] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/.- Number of bedrooms 1"_- Number o Baths --/--- Lot size _---- ------_----_ i Water Supply: Public system F1Community system Elvate PriDepth to Water Table ........ ft. 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r an Distance from nearest well----r�Q_----- Distance from foundation------o0--- -.Material----V- =_.-. No. of compartments..----------f---- ----Size--a ---------------------Liquid depth--c�--.-----..----- - Capacity--- ----.--- -- ---- pis os Field: Distance from nearest well--�F ..---.-Distance from foundation___h ----------Distance to nearest lot Iine_.4�7------- LdNumber of lines------------/-------.------------Length of each line___-__._5m 'm_ .-.-_--.Width of trench---;?t/------------------------ Lpt Type of filter material-_-_-r ---_----Depth of filter material----._��_. -.--.Total length------- - -------------------------- �r Seepage Pit: Distance to nearest well------------- --------Distance from foundation--------------------Distance to nearest lot line--.--.-.----- ' ❑ dumber of pits-----------------_.-Lining material-----------------------Size: Diameter-----------------..----Dept h.---------.---------------------- 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- ------ --------- ----------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---- -- - ---------- -----------------------------,: --t--------------------------- - 4 --•------------ -f -- -- -----------------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 aw and rules and4ofs ons of the San Joaquin Local Health District. (Signed)------------ ---- ------- --- ------•--------------- ------- rand/or Contractor) By: t (Title) (Plot plan, sho g size of lot, locatioem in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r= APPLICATION ACCEPTED BY r: tr+s ��' -------- ----------------------------------------- DATE-------- `-�`�--�- ,Jr----------------------- 1. e,#/5----------- ---- Y-�+� REVIEWED BY-------------------l-4 DATE.__. K- BUILDING PERMIT ISSUED------------=--------------------------------- --- -------------------------------------------------------- DATE -------------------------------------------------------- Alterationsand/or recommendations:------------------------- ---------- ------- ---------------------------------------------•-•-------•------••--•-----•-------•-••---------------------------- ----------------------------------- ------- --------------------------------------------------------------- -------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ---------- --------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-__-- -: ____ Date_-. 1. --.�-�l 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 B-59 3M 3-'63 F.F.CD.