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FOR OFFICE USE: �3 ----------- ----- --- ------------I-------------------- ---------------------------------------- ------------- -------------------____________________________________________-_._________ APPLICATION FOR SANITATION PERMIT Permit No. Q.- _G�_C� ---------------------------------- --------------- (Complete in Duplicate) This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct.and,install the work herein des ibed. This application is made in compliancpe, /with County Ordinance N'g. 549. JOB ADDRESS AND � ------ I? ---- ------- --- ---------_----------------------------------------------- _ - Z --f- -D Phone -Owner's Name--------- ..... L{� Address--------- --------- 1 -------- n - = .� --------------------- -------------------------------------------------------------------------- Contractor's Nam .s - y------ ------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer ourt E] Motel E] Other F] Number of living units: --/-- Number of bedrooms _. _ Number f"baths _ _ Lot size Water Supply: Public system E] Community system El Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E] 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.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_____________._________.___________----___-_._. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------- ----------Capacity----------------------- Disposr�I�Field: Distance from nearest well--- - Distance from foundation___... 4'__�__Distance to nearest lot line- , --------- Number of lines__________ __----------------------Length of each line----------7.�,X Width of trench______,;1;P-___-_________________ Type of filter material---_..02-YZr._______Depth of filter material-______-/J�f__.__Total length-------;A11"Flo-"______________________ Distance to nearest welL______/2a___-Distance from foundation------ Distance to nearest lot line_.____'----.__ ❑ Number of pit9---------- ---------Lining material-,fA1_ ----:...Size: l] ,e+er._._ _ Depth----- _ Cesspool: Distance from nearest well---------------__Distance from foundation___------------._-.Lining material_---------------------------------- !p ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________________________._____.._. ❑ Distance to nearest-lot line----------------------V----------------------- ------------------------------------------------------- ------------------------------------- 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 ordinances, State law a rules and regulations of the San Joaquin Local Health District. j i ------ ------:-' D -- ---------------------------------- --------------------- Owner and/or(Signed)---------- _ ( / Contractor) $Y� -t3 ------�L--------- -- ��—` �------------------------(Title)----== .------ -_------------- (Plot plan, showing size of lot, location of system in relation to weird, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------ APPLICATION ACCEPTED BY--- - ---------------------------------------------------------- DATE----I'/_'t!1/_' ---------- REVIEWEDBY-------------------------------------------------------------------------------------------------- ------- DATE------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------- --------------------------------------------------------- DATE---------------------------------------------- Alterations and/or recommendations---------------------------------- ------------ --------------------------------------------------------------------------------------------------------------- -------------------------•-------- -----------•---------•------------------------------------------------------ •--•----------•--••-•---------•---•---•----------------------------------------•-------------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------- -----------•------------------------- r FINAL INSPECTION BY:- r '�K--------------------- Date__... r�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 E5 4 REVISED 8-59 3M 3-'63 F.P.CD. 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