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FOR O FICE USE• " -- ---_ - _--_.--_l�___"____------. .v-OXM-ICATION FOR SANITATION PERMIT Permit N0. . :�../.... . ------------------------------- (Complete in Duplicate) �5 . _.� Date Issued --- ......... / _-_____:_Y_" _._ ._""" -This Permit Expires 1 Year From Date,lss e'd �; ----- ------------ - - - - , I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with COrdinance No. 549. { JOB ADDRESS AND LOCATION-... a-/=: ount Owner's Name--- -------------- --------------- Phone__.------------------------- Address -- -s>n = , ... Contractor's Name------------ 7�1.'------------- -------------------------------- ----------------------------- Phone............._-------------------- Installation -------- _=Installation will serve: Residence M Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___!__: Number of bedrooms _1?7-_ Number of baths J____ Lot size ___ ________________________ Water Supply: Public system [K' Community system ❑ Private ❑ Depth to Water Tablec.5--c---_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe E3—Hardpan ❑ Previous Application Made: {lf yes,date------------------- No [� New Construction: Yes BNo ❑ FHANA: Yes ❑ No P TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Septic T nk: Distance from nearest well��---_----Distance from foundation__ZP_______`___-.Material_________ ______________________________________ No. of com artments__-_----__�2—----------Size_______-3 ___Liquid de th---_.51 - Disposal Field: Distance from nearest well _"___._._.Distance from foundation,/je_____________Distance to nearest lot line___ Number of lines------i______i-___________________Length of each line----q4?---------------------Width of trench------- ,Y_y______________ Type of filter materiaLC-_ __---__-__Depth of filter material_1�`�_______-.-__Total length_______--,5P__________------ -------- _. _.. Seepage Pit: Distance to nearest well/ ............Distance from foundation....... Distance to nearest lot line.45------------ 09Number of pits-----+✓---------------Lining Size: Dia meter._. .............Depth---- ---- Cesspool: Distance from nearest well_________________Distance from foundation---__________:____.Lining material-_____._____-__-__--_-...---:...... . F-1 Size: Diameter--------=----------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. 4 Privy:; Distance from nearest well l___---___-_y�___�--,^--------:___ ^_Distance from nearest building_________________________________.____. ❑ Distance to nearest lot line----------------------- - ------ ----- ---= ----------------------- --------------------------•----- ------ ------•----------`-----=- r � I - -- Remodeling and/or repairing (doscribe):------ a-. --- ----------------------- - ------ -•----- -•- ---------- - -- ------ ---- �---•- - --------•------------------------------------------------------------•------------•--•.....------------•----••---------------------••----------•-------------------- --------------------------------------------------------- -•-•--------------•-----------------------•--------------------------------------------------------------------------------------- --------------------------- I hereby certj11hJ1J1 p epared this application and that the work will"be done in accordance with San Joaquin County ordinances, State r es nd egulations of the-San Joaquin Local Health District. (Signed)----------------- - -- • --- --------------------- F ----------------------------------------------------------------------.(Owner and/or Contractor)ill � ` Title J By:--•----------- ---- --------- -----------------------------=------ --------••---------------------- (Pla# plan, showingt, Iota#ion of system in relation to wells, buildings, etc., can be placed on reverse side). i I FO!,,DEPARTMENT USE ONLY [[ APPLICATION ACCEPTED BY- y -----•------------------------------- DATE------- t� ---------- .. REVIEWEDBY--------------------------------------- -- -------------------- -----------------------------=------------------------- DATE------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------- --------------- ------------ ------------------------ DATE----------- --------------------------_•--------------------- Alterations and/or re ommendations: 1----------------------`_ _ _ --•-••----_-•---- 1_7 _ 1F �� --____-•--------------------------------- // --------- ---------------------------------------------------------------- -------------------------------•-•-•----------------------------------------------------- ---------------------- ------------------------------------------- - ------------------------------------------------- -----------••--•------------------_._____------------- ---..-----•---•------------------------------------------------------- FINAL INSPECTION BY:. j----C--- • ------ - - ---- ---------- ------- Date 1 ----- -- ---------------------------- , N JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,Coiifornla Tracy,California EB-9 REVISED 9-59 r.P.D D.2M 6-60 . k