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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..... --------------------------------------------------------- �_ .4. .. ----------------------------- ----- --------------------- (Complete in Duplicate) Date Issued _.1_�- _!{.��3 --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Q2S� iS'i7 Scl 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. lSo l� JOB ADDRESS AND LOCATION ------- -- -- 71... x --F.t�-�- - -+"r- . .e?✓^ .._A Owner's Na '----------------- -- -- - ------- ---- --._.... Phone...------------•-----•----------•--- Address------(70-Ig..- ._ ------_-7-- ---------------------- -- r------ -- -- ------------------•-----....--.....-------------------------------- Contractor's Name---------- --• ' n --------- - - ------- -- Phone----------------------------------- Installation will serve: Residence Apartmen House ❑ Commercial ❑ Trailer Court Court F] Motel E] Other Number of living units: --/-_ Number of bedrooms Number o Laths _/_'-_ Lot size ___-_ --______ _.__ ____________________ Water Supply: Public system El Community system [-] Private pth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date----------- ------1 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.) 1 Septic ank: Distance from nearest well____oYh�__�Distance`from foundation____6?_.__. _.Material____----1_/_ _ No. of compartments---------/2-- __. ------ ___(2___�T-- __ .___Liquid depth________�j.�_._________ _Capacity_.L s s Dispos field: Distance from nearest 'well_.-._ p___Distance from foundation---j0---_.._..Distance to nearest lot Number of lines.........?___.__. Length of each line________ ____________Width of trench______ -_ of filter material ,--y_+_________ Depth of filter material__._._� `s________Total length___. ---------------------------- Type ' Seepage Pit: Distance to nearest well----- ----------------Distance- from foundation----------------.-. Distance to nearest lot line--__-_.-__--_.- ❑ Number of pits______________________Lining material______.__.---.__.___..Size: Diameter-----------------------Dept h-------------------------------_ rom nearest well__________ ------------------ __ __-.__Distance from foundation material________ ________________ Cesspool. Distance f ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------- _-gals. '} Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------.--------__-_______ 'f F-1 Distance to nearest lot line --------------------------------------------------------------- ------------------------------------ -- - Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------•---------------------------------------------------•---• ---•--------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ----------------•------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State i and rules a ,regulations of the San J uin Local Health District. r _�p c (Signed)------------ -- ----------- -- ------- - -•- -- -- -- - ---- ------- /----------------- -------------- ------------ wn ' nd/or Contractor) By:-------- ------- -i--. ---- - -- -- ---------------------------------Title------------------------------ - ------ - ---- --- - (Plot plan, showing size of lot, location of syste in relatio o wells, buildings, etc., can be placed•on-reverse side). - --^ FOR DEPARTMENT USE: ONLY APPLICATION ACCEPTED BY---- ------------- ---------------------------------------- REVIEWED ----------------------•---------------REVIEWED BY---------------------------------------------------------------------- ----------------------------------------------------. DATE-------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------- ---------------- DATE-------------•--------------------------------------------- Alterations and/or recommendations----------- ------ - ---------------------------------------•-------------------•---•--------•---------•-------• -•-----•------------••-------------- --------------------------------------------- --- ------------------------------------------------------------------•----------------------------------------------- ----------------------- ---------------------------- ----------------------•--------•--------------•------------------------------ ----------- --------------------------------------------------------------------------- ----------------- ---------------- --•-------------- --------------------------------- ---------- --------------•------------- -^----------------•-------------- ----------------------------------•---- ----------------------------------------------- --------------- ----- FINAL INSPECTION BY:I��G ---•--------------- Date---.�Z - `J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3m 3--63 r.p.c[].