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3�R OFFICE USE: --S 3__C-7- -------- ----- �-- --- - Permit No. ,�.��o APPLICATION FOR SANITATION PERMIT -- ---------------f __-k.,_ (Complete in Duplicate) _ .. Date Issued __-? This Permit Expires 1 Year From 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. :l " ' " - JOB ADDRESS AND : CATION. �f,); � `� Phone------------------:------- ---------Owner's Name_: __ - . . - � -------------- - -- ---------------•------------•----------------------- �-------- -------- Addres � ------------ Phone...... ----- - - Contractor'sl Name------ --- Installation will serve: Residence E] Apartment House El Commercial E] Trailer Court [I Motel [j Other I '"�' Number of bedrooms'_ Number o bathsLot size •� / / ------------------------------ .Number of living units: __.___. g Water Supply: Public pster.n ❑ Community system ❑ Private Depth to Water Table ______ ft. Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Elr Clay Loam El Clay ElAdobe[Hardpan ❑ Z Previous Application Made:::(if yes,date--- ------ ) No F1 New Construction: Yes E] No E] FHA/VA: Yes El No ❑� TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:)- ' - r Septic Tan Distance from nearest well--- Distance from foundation____ "�_.___.Material_-__�� ------- No. of com artments-----__ Size' �f �_. fLiquid depth---- __------------------Capacity�a C�_ __-- Dis os # p �------- ---- p Field: Distance from nearest well.---'�_____-___-Distance from foundation_,_..__---------- Distance to nearest lot line_____ 1_--_- 11 Width of trench ---- - ----- ` , Number of lines________ Len th of each line___-_-�_ 9 t i,. Type offilter material____._-SJ-•-____-_Depth of filtermaterial____f�-- Total length___ __ ____________ _�___- Seepa Pit: Distance to nearest ell------IQ0-`-- Distance from foundation____.. �:� --Distance to nearest lot li.ne------------------ L Number of pits Lining material__,__- -` :----.Size: Diameter_____�............:..Deptn__�� 1 '= �? Cesspool:< Distance from nearest well----._-__--___-Distance from foundation-- '__ _______�ining material__--__._.- __'___._-________________. Size: Diameter-----_------------------------_---:-Depth---;�---,;------------•_,-- -�_-------� _-rkLiq- uid Capacity-.------- ------------------gals. ❑ :Y T — --- ----- ----=- - Dtstance�rom nearest building ------ --- ------ --- ------ Privy: Distance from nearest well----- ❑ ------ ------ --------- ----- -"------------ ---------•------ Distance to nearest lot line Remodeling and/or repairing (describe)=----=-------------- --- '`----=---------_-------•- --------------------------- --------------------- Y 1 _____________________________________ ______________________ I 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. - -(6wt'tsr and/or Contractor) _____ "____."__ _____*ys�,, jn _______ _-.--_______-____----___-_---___.----__-__-__----_________-__."______- i „ (Signed)--------------------- -- - - r �— (Title)--------------------- ---------------------- ------------------- By:---------------U--, ------- ---- ---- -------- (Plot --- - (Plot plan, showing size of lot, location of- n to wells,.buildings, etc.,,can lie placed on reverse side). FOR DEPARTMENT USE ONLY , DATE-------- `-� -7---------------------- � t APPLICATION ACCEPTED BY--_--G ----1----- -- - ------ - ------- - REVIEWEDBY------------------------------------------- ------- ------------ -- - ----,------------- - - __.:'- - DATES BUILDING PERMIT ISSUED------------------------------w - -7- - - DATE----------------- -- ---------- - --------------------- Alterations and/or recommendations:------ ` 5- .-------- s . W-4')-----Z.>/_ e -- °'�'nce ._.lS =--------------------------------------------- 1 9 ----------•---------------------"------------------------- r ............ Date_" �i FINAL INSPECTION BY:..-_._..- _--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.R.GD.