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j APPLICATION FOR SANITATION PERMIT Permit No. -...--- - .._ (Complete in Duplicate) This Permit Ex fres i Year From Date Issued Y Application is hereby made to the San Joaquin Local Health District for a permit to construct and in Date Issued _•______. __.�.__� y This application is made in compliance with County Ordinance No. 549. / stall the work herein described./ JOB ADDRESS AND ATION_"-_______ 7t !_fit---•- ------------- Owner's Name_----_"""-- ---•---•_ -- Address---------------------- -- Phone - ---- ----- onfiractor's Name__________________________ __----- Installation will serve: Residence W Apartment House - --•- �----- --•-- -- -------•----- ---- ....... Phone- -- - --•- ❑ Commercial ❑ Trailer Court ❑ Mofiel [j Other ❑ Number of living unifs: /- Number of bedrooms " Water Supply: Publics stem Number of baths --/-- Lot size __-_.._-_-.�d ' ' Y Community system Q"�---""-------- Character of soil to a depth of 3 feet: Sand ❑ Y Grav�❑Pri$andy❑LoaDeOh tClay Loamo Water E] .0 a {t, Previous Application Made: (If yes,date----_--------- ----- ❑ Y ❑ Adobe Hardpan [] ) No E] New Constru TYPE OF INSTALLATION AND SPECIFICATIONS: ction- Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ t'Nptic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-__---_____-----Distance from foundation_-____-___.."No. of compartments------- -------------- Size Material-.--------------- Distance from nearest well--------.-- Liquid depth-------------- Capacity__-"_-. .-__-_Distance from foundation______________ Number of lines-------------------------------- ------Distance to nearest lot Line.___-""_--_--__- r --- Lengfih of each line Width o{ trench. Type of filter material_.------- """------_----Depth of filter material----------------_-----Total length-----------------_-----------.------- --- 0 5eee Pit; Distance to nearest well Distance ,rom f undation__ _._Q__--___--Distance to nearest lot line _ .___ Number o{ pits -------/----------Lining material .. - -Size: Diameter__ ------" De th------- - Cesspool: Distance from nearest well___ __Distance from foundation.-_""_-"___-_ p �� ❑ Size: Diameter------------------- Lining material._.------------- -Depth-------------------•--------------------------------Li uid Capacity.. ---- els Privy: Distance from nearest well----------------.-----"-_ - q -------------------------gats, .000 ❑ Distance to nearest lot line__.___-_--" Distance from nearest building-___-.-"._"_____-_ ------------------------------•--- - - --------------- - ------------------- Remodeling and/or repairing (describe)_________ ________ ---- ---•------ ------- ------ ------------------------------------------------------------------ ------- •--------------------------------------•-------------------------------------- - - ---------•-------------------- ---- ----------------- ----------------------- ------------------------------------------------------------------- ------- , I hereby c fthat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SF�' ws, and rules and re ulations of the San Joaquin Local Health District. (Signed)--------- - -------- ----- -- --------7�/ -------dA__ wrier and/or Contractor! t-__ By:------------------------------------------------- ----------------------------------- --------- -- itle} (Plot plan, showing size of lot, location of system in relation to wells, buildings, et e, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_....C.,.- a ...... ------------------------------------------------------ DATE-----�---'-•I-------- BUILDING -=-- } ---------------------- -------------------------------- ----- DATE-------------- ------------- BUILDING PERMIT ISSUED______"""•__"._________-- __ """�`"""--- ------------------------------- -------------------------------------------------- ---- DATE---- Alterations and/or recommendations------ ----------------- ____________ --- - -----------------------------------------------------•---------------- -•--- -------•-------•--------------------------------------- ---------•-------------- --------------- - - - ----------- --------- ------------ --------------�✓--------------------'r�•_Z ------------------ ------------------- ------------------- FINAL INSPECTION BY:.____0 Date ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 5-59 3M 3-'63 F.P.qD,