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FOR OFFICE USE: ° ------------------:--- --- -- ------------------ -- APPLICATIOWFOR SANITATION PERMIT Permit No. ___.�._._._... (Complete in Duplicate) r - -.,T...—r� -__•. _._"_ _ I -�_ . Date�Issued�--`---------�----�� _._._ -- This Permit Expires 1 Year From Date Issued 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. ' JOB ADDRESS AN ATI. f.._�-_ '_____ _ _________ _._ : - -------------------- r OwnersName- -- -- - ----------� --- -- ------------------- Phone------------•----------------------- 3 -- E Address.-----••---- ----•-- ' o--- ,�- - -..... Contractor's Name--- 4-- -- ----------------------------- ----- Phone ------•---------- ----------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Gs"+ emotel ❑ Other ❑ s Number of living units: __�_____ Number of bedrooms __yNumber of baths Lot size _____ -- --------------________"_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam E] Clay Adobe [] Hardpan ❑ ' Previous Application Made: (If 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 wi4liin 200''feet-)-:° Septic ank:"' '4 Distance-1rorn'nearest �a___Distancerfr'•om f undation____, ----------M trial__ _ _______ ,,g No. of compartments__._-___7! _i;.._-_Size._,tr_1U_Xj---. q __Capacity.... d Liquid depth. - Dispos geld: Distance from nearest well__-. 10_`,- Distance from foundation-.l6------------Distance to nearest lot line-St.._____.. ' ___Le_ tli"of each line__ �'e�____-_-__________.Width of trench___. _____ ____________ __ Number of lines---..--- .---,--- ---- - ..L Type of filter material_,/�r�Crf" .___Depth of filter material____I�°"_-_ Total length-------------------�_"�__________ f�^ Seepe Pit: Distance.to nearestII_____f d0 -----De__._____Distarice from foundation to nearest lot line__.. th.......02 Number of pits_________w_________- Lining mater __ !_---Size: Diameter____._ e ___ p Cesspool: Distance from. nearest well= ' "_ ____-'Distance from foundation-------------------- material-------.............._______-________. i ❑ Size: Diameter------ •----------------------- Dept ---------k----------------------------------- I .Liquid Capacity- - gals ___._--.Distance from . ' Privy: Distance. from nearest well_________________ _------____________. nearest building_._______-____-_______________f�._.__. ❑ Distance to nearest lot line--------------------------------- ;-}--------------------- ------------------------------------------------------------------- .,. .A► 1: Remodeling and/or repairing (describe.):------------------------------------- _ ---------- , , --------------------- � -------------------------------.-----------------------.----------------------------------------------------------------------_----.-___________________.______________________________-______-_....__..__.__.__ . I hereby certify that I hay, prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and r es and re U1 tions of til an Joaquin Local Health District. _.____ wner and or Contractor (Signed)-------- / ) By: r --a (Plot plan, showing size of lot, location of sys+em.in rel on to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - • - -------------------------------------------------- DATE--6e !'^3---------------------------------- REVIEWEDBY--------------------------------------------------------------- - ---------- ----------------------------------------------- DATE-------------------------------------------------'------- BUILDINGPERMIT ISSUED---------------------------------------------- -------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommends+ions:-------------- ----- ----------- -- -------------------------------------------------------------- ---- --------------------------------W- ----- -------- ----------- ........................................... ---------------------------------------------------------------- ------ ------------------- ----------------------- --------------'-------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- --------------------- . 3 FINAL INSPECTION BY .- : - - -._-"-- -- -- _._ - Date--- ------------------------------------ -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California ES 9 REVISED 9-59 3M 3-'63 F.P.CD.