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� / V f. - " ---- APPLICATION FOR SANITATION PERMIT Permit No. -_-__---------------------------------------------------------- (Complete in Duplicafa) S( Date Issued ------------------------------------------------ This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health istrict for a permit to construct and install the work herein descrbed. This application is made in co lid ithlCr:opnfiy �� n& (�Ce/ JOB ADDRESS ANDD LOCATION__/r�.-- - � _ - ------ - '� - --�..r•�`•`" �'__�: ___.._. __ ..c__________________ Owner's Name------ =-------- ----�- ----------------------•------------------------•------•---------•- Phone---------- -------•----------•---- Address----------------------�-,3---3-j2l----I,/---*OF ----------- yTx Y" - Contractor's Name---------- ------------------------•----------------•--------------------------------------•---•----------------------- Phone----------------------------------- Installation will serve: Residence fH Apartment House ❑ Commercial ❑ Trailer Court ..❑ -Mt5fJ-0 r ❑ Number of living units: ..---_ Number of bedrooms _ _-- Number of baths -;?,!f_-_ Lo size r -_.-.'__-.•________________ Water Supply: Public system ElCorrimuriity system E] Private a] Depth to Water Ta ft. — ' f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam-M Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------............) No M New Construction: Yes_M No ❑ FHA/VA: Yes ❑ No ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: DC (No septic tank or cesspool perm'itted'if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well—SA—L.—DistancQ from f ndation. # ------------------------------------------ �] No. of compartments-_.-__-�-------------Size. '`__----_"____.-_.•__Liquid depth-_-_-__-_-_------------------------Ca aci P tY = Disposal Field: Distance from nearest well.A'a_.�---.-_Distance.from founclation__?�O_j__-_-.._Distance to nearest lot line__.�7y--_--_. Number of lines_____ ________________________Length of each'line-1.�-.q-1q .#_=7__0_:W- idth of trench_:: ,-,____----_-- Type of filter mat enaL ik '��------Depth of filter material----14_-------------Total lengt6..'A_6_a__-__------ ------ --- Seepage Pit: Distance to nearest well----------------------Distance from foundation;_____.-------------Distance ton st of line____._.____-____ S ❑ Number of pits----------------------Lining material----------------_........Size: Diameter------:_------.--------Depth--------------------_ _ _. _-- -1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- - S- ❑ Size: Diameter--------------------------------------Depth---------------------- ---------------------.-----Liquid Capacity----------------------------gal Privy: Distance from nearest well------------------------_------------------------Distance from nearest building--------------------------____----..-_. . ❑ Distance to nearest lot line----------------------------------------------------------------------------•------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------•------•---------•---•---------•-------------------------------- - --- ---------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------•---------------------------------------- ---------------------------------------------•---------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- hereby ce i _th-at..J_h ve prepared this application and that the work will be done in accordance with San Joaquin County ordin �Fes;-Sta I"ws, and rules egulations of the San Jo anquin Local Health District. .(Signed)--- •---- -- -•--- --------- --- y------ -------- ------------ - .(Owner and/or Contractor) By:------- ----------------------------------- ----- ----------------------- ----------------- -- -- ------ -- -- ---- ------(riifle)--------------------------------------- __... .- (Plbt plan, showing size of lot, location of systeJn ' e ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.';:-' -- . A-,`- -------------------------------------- --- - --------- DA E ------------,--------------...._._.. REVIEWED BY DAIS -------------------- BUILDING PERMIT ISSUED. �."`" -----_. - ; -- DATE Alterationsand/or recommendations--------------------------------------------r---------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------•------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------•----------------------------- ---------------------------------------------•----------------- ---•--..--------------------------------•----------------•----------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. -9_zr .:,. - ------------- Date_&........f �-...-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E-Haxelton Av*. 300 West Oak E'reet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED ©-59 3M 3-'63 r.P.CO.