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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 1_ ..._ ... --- -------------------------------- -------------------- i - ------------------------- (Complete in Duplicate) Date Issued -- _---__--.-_- This Permit Expires 1 Year From Date Issued # Application is hereby made to the San Joa uin Local Health District for a permit to construct and install the work herein describe i This application is made in compliance with County Ordinance No. 549. U Pj � I JOB ADDRESS AND LOC�ATI,ON = ` Ph - ----------------------- --------- ---- -------- f Z---•- - ----- ----------- one Owner s Name---------- ----``� �-------- Address ..-- ' ��' � -� �-•• one..._.. - - -- ,,` __._ ij Contractor's Name------------------•-----------•--•------------------F-��_ Ph JJ Installation will serve: .Residgrice ❑ Apartment House 1 Commercial Trailer Court ❑ Motel � Other ❑ �r ---Number of baths -------- Lot size --------- �.. '-------- ---------•- I Number of Number----�-- Number of bedrooms ___.__ Water Supply: Public system ❑ Community system ❑ Private � Depth to Water Table __/Oft. Character of soil to a depth of 3 #eet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpans r❑ date__________________.) No�-_ New Construction: Yes No ❑ FHA/VA: Yes ❑ No}❑ Previous Application Made: (If yes, // `` _ TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 -- Sep.i Tank: Distance from nearest well__ �_�____-Distance fr fou�ation___._____ ----- _ '� Size : 111 Liquid depth-- = ' Capacity . No. of compartments_ _ L)--Distance to nearest lot li�n,J______________ � Dispos I Field: Distance from nearest well_____�_��.-_.Distance from foundation._____---------_.�_.__ I Number of _ lines-----1Ff/-Length of each line--------70------f,-- Width of french---�-- ----------=---------- Depthof filter material----_ _Z�--.---Total length------ ------------------------ Typeofilter material-„2.. -1-7;- t M Seepage Pit: Distance to nearest well---------------------Distance from.founda#ion____-_____k__-____.Distance to nearest lot line____.--________ ❑ Number of pits Lining materiel ------------Size: Diameter-- Depth------------------------------- Cesspool: Distance from nearest wail------------------Distance from foui,dation--------------------Lining material---------------------------_-_______- F Size: Diameter-------------------------- -----------Depth----------------------------- ----------- ---Liquid Capacity----------------------------gals. 1 - � istan`ce`frnm n9 Privy: wnearesbuiid ------------------------------ ----------� Distance to nearest lot line--------------------------------:-------- --- - - ------- ---------------- -------------- c r ' Remodeling and/or repairing 'J-------•---------------------------------- ---- - ------------•-------•------•------------------------ - = =-•----------------------- ----------------------------------------------- ------------ -- ------------•------ -----_----- ----------------------------------------------- -------------------------------------------------.--------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations o,-the San Joaquin Local Health District. /2//c ^� ____Owner and/or Contractor) n -------------- 7 [Signed)--�---- -� • --------L'------------- ------------------------------------ �-----.:-------- / - - ------------------------------------------------- (Title)- ------------------------------------------ ------------------ (Plot -- -._. ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -1-- _-- _ DATE-------------------------------- -. ----- APPLICATION ACCEPTED BY_ ----------- - ------------------------------------------------- -- i REVIEWED BY---------- ------------ ----------- 4 DATE-- ---------------------------------------- - ------------ BUILDINGPERMIT ISSUED----------------------------------------------- ---------- - --------- -- Alterations and/or recommendations----------------------------------------------------•--------------- ------------- ------ --- ------------------------- ------------- -------- ------------- ----------- ---------------------------- ------------•------------ - � --------------------------------------------------------------- ------- , ` - ----------------- -------------------------------I- ----------------- ------------ --------------- --------------------- ._ ------------------------- --- oyT -------- EFINAL INSPECTION BY------------------/------; ------f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,Califofnia Lodi,California Manteca,California Tracy,California i;5 4 nEVjsED 9•S9 3M 3-'63 r.P.CD. _.