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C FOR OFFICE USE: t _ / -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _47o _ . (Complete in Duplicate) 7 ---------------.__-...._..... This, Permit Exeires 1 Year From Date Issuod Date ISSUed'-/ _ >4_ 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- t*v .-S D �T ?sol - t J ADDRESS AND L � -_.._ -- - JOB Owner's Name- -------•---- •----•- .. . -.....------------------------------- --- ---- ---------- --- Phone---------- Address............... --Address...............-_-• __----••----" _._ __...._._- _- -- -___ .______r:..:.•.... —_:_::_ --_:- '------ Contractor's Name-------------------- a.. ..--- ------- -..-- -- Phone----... _i ---•---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other 12� �- Number of living units: ---/--- Number.of bedrooms __-_ --- Number f baths _��_.� Lot size _......._. ______ Water Supply: Public system El Community system ❑ Private depth 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__-------__------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well_ftSi -------Distance ff m foundation_-/�! Mater�af_.__ ... j f' No, of compartments.....-_ .-. _ _...._size. ��.�` _�iquid depthr..- � _..___Capauty` � .y Disposa Ield: Distance from nearest weR._Sfj_._.Distance from foundation._- _ Distance to nearest lot line_---_-_•_-_ Number of lines_.._____- Length of each line__-.` "___.*-_Width of trench_..�..`.�'�__:_._.._ �! of filter material_ t _____Depth of filter material__._........_Total length_.. ix_:.'_:__-------- Type ........ _' # t Y Seepage Pit: Distance to nearest well.-----------•--..._Distance from foundation______--------------Distance to nearest lot . [] Number of pits_..................__Lining material------------------------Size: Diameter____-----`------- ._Depth--------- Cesspool: Distance.from nearest well._•--.-.------:Distance from foundation._..................Lining materia!___ ---------__.j`!.___........ � El Size: Diameter--• ---=-•••---.-...-----••••.-••_De th.....:.-----•-__--------------------------- --Liquid Capacity.........--I -t--- . t Privy: Distance from nearest well--------------- ___._Dia#ante from nearest building___---,---_---- ❑ Distance to nearst lot line----_------_..__.._-.. ..--..------••.-------_-.-_--__.___ .. __-----..--_____----._.- --•----_--•-- 4-1 Remodeling and/or repairing (describe):---------- ---------- __.._.�-------•------ - --------------------- ------- .••. -----...-••-•----•--•-._.---••-.--- --. .. ---•------ ----------- -------- -- - _`- --- ---- - - �. -------------- -- — -------- ___ -- -- -- .---•-•-- I 1 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. ! (Signedl------- - = -- ................-.--------- __.-------------------• -�lo�od or Contractor) By:------....- - --------- (Title)............................... _----- � �+ (Plot plan. showing size of lot, location of system in relation # ells, buildings, etc., can be•placed on reverse.sidel FOR DEPARTMENT USE ONLY U / r, / O APPLICATION ACCEPTED BY f -- _— - --- - DATE rC.-`-,F�G 7 D.- - -------•----.------ REVIEWED BY---•------ BUILDINGPERMIT ISSUED--.-----------------------......_.._a-------------------------------------------------- DATE----------—-------------------=---------------•-- Alterations and/or recommendations:------ ....._....................................----------------------------------------------------- - ---•--.-.�._.__._�.-..._.... _........ ------------ - - --= ------------------------ - -—--- - -- -- - �__ .._. ...- ----------•--- i t -------- ........---•--------------- ----- _- - ._.... ---------------------------------.....................-................-------------••----• FINAL INSPECTION BY. Vrr_/ ----:---- -------- Date -7- � -- - ----- _--••----_.._..__--- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lilmelton Ave. 300 West Oak Street 124 sycamore Street 205 Wast 9th Sheat stealon,California Lodi.California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. �•.