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FOR OFFICE USE: t ...................:.................................... // ......................................................... APPLICATION FOR SANITATION PERMIT Permit No. .__....-•-,- --- --••---•--•---•- ...................... (Complete in Duplicate) .._..._. This Permit Ex fres 1 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 described. This application is made in compliance with County Ordinance,No. 549. D(3- (ev —S 40 J08 ADDRESS AND LCATfON- c.��__ �G O Owner's Name ---------•-- •--•----•--•----- ------ ------- Phone Address............... --------------- --••----- --- ----•-•---•---...-----.._....------- _. Contractor's Name............ ... -- 42 r Phone -----_- -• --------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ._�... Number of bedrooms -----... Number f baths V� Lot size ------1_/__d......-_.......... ... _.._. ___ t Water Supply: Public system ❑ Community system ❑ Private Depth Water Table .- .-- - ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date ...: ) No New Construction: Yes ❑ No F] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' } , _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well,,c__'�C?.-.._.Distance 1 m foundation---«f------...Materia] --11: _.-'._ - -----•- � � '�s t No. of compartments____. _-_._____.Size_,/ squid depth___-__ Ca acit s . Dispose teld: Distance from nearest well__.�nft._...:Distance from foundation_/t!t __-__-_:_Distance to nearest lot Ilne_cs__-!________ I Number of lines.--------. Length of each line------ _ ___*-_Width of trench__ 'JK.��_�___.___ Type of filter materiaL.� ......Depth of filter material-___. .-___. Total length ----- -- Seepage Pit: Distance to nearest well_.__ ................Distance from foundation...................Distance to nearest lot line._:_.__.________ `� ❑ Number of pits__ -___--Lining material-----------------------Size: Diameter...........s_...-------Dep --- f___..,: ...._____ Cesspool: Distance from nearest well------_________-Distance from foundation__..________-_._.__.Lining material____-_______-__..J'r____-_...... Size: Diameter....-------------------- ............De th-____________________________ --Liquid Capacity_.-------- Privy: Distance from nearest well.................------------ — -r•_-}_ o Distance from nearest building_.____.----------___ - ❑ Distance to nearest lot line....................................--................................................-----•----------- Remodeling and/or repairing (describe):......................................................................................... � J ; 1 ( . t �_.w ---------------........................ .......................I._.._......___......__.___...._....._ _______________________________________________________________________________________________________________________________________-----_____-_-___--._______..-_..__.---_---._-.___..____,-___-.____ ..________..._- _ _ r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - _ - - - - --- - ----------------------- -------- /or Contractor) 1 es Title ---... - f Plot Lan, showing size of lot, location of s *feinelation t wells buildin s etc. can be, laced on reverse-side( P 9 Yg • P )• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... ..... ..... .. .. ....................................................... DATE----7'_.f...G-7.-............... f REVIEWED BY_. •-•---------• [ ._.... DATE--------- .................................................. BUILDINGPERMIT ISSUED................:................:...••---'----•-----.... ..._------......__._......----•-....---... DATE............................................................... . Alterationsand/or recommendations:.................................................-•_......................................................................................................... 1 I = .............................................................................. ............ ......--••--•.............-•--••--------.........................• --------••-•----•-----•••••--•--•--••-•...•---..._...........•-----•--•-•-•--•----------....-•---....--•.....-••....._..-...._.....__........... '.-----------------------------------------------------------------------•-------------.___.--------------------------------------------------------- ..-.-_____--__---------------_--_-_-_----.----_-_--••---------•---•--•---- FINAL INSPECTION BY: . -------------- Date_.- ---;1...... f' .........--••-•-•--•----•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California t Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.DO. it _`