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FOR OFFICF_ USE:-: ` APPLICATION FOR SANITATION PERMIT Permit --------------------------------- --.---.----- ------ -------------------------------------------- - ------- (Complete in Duplicate) Date Issued 7 ----------------------------_---______........... 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 Coy Ordin n No 549. JOB ADDRESSONLOCATION . ! - - -----�- -------------------- - ----- •------ ------- -------- --------------- JOB Name_ - - e-� -� * $ Phone------3 7� g` 9 ._. Contractor's Name----------------------------- --------------------------------- Phone__-�//�4_-1- ! Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ Number of baths / __ Lot size _fes:------ '______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,/0 ft. Character of soil to a depth of 3 feet: Sand % Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------- -----) No ❑ New Construction: YesW No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) T i Septic Tank: Distance from nearest well_ ____ Distance from foundation_-Q---------Material----__.________ _______.._..__-._-- ---------- No. of compartments._._._..__ 'y�as ,�=_Liquid depth____ Capacity_2Q.QQ- ��C/ -------.Size---------- -------- � - ,�Q-...____Distance to nearest lot line____5.......... C>, ispasal Field: Distance from nearest well _Distance from foundation__ ___ � Number of lines__-5________ ____ Length of each line °-3o-�,-)r-7SVti/idth of trench-_s ____ _��_ ---- --- -- -- Type of filter material.-___ __ ____________Depth of filter material_ _____________Total length___-____--_ lWY- -- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------;.__ Distance to nearest lot line----------------- El Number of pits----------------------Lining material-------------------.---Size: Diameter---------------------- Depth---------------------------_ _.-- 411 Cesspool: Distance from nearest well_______________ Distance from foundation___'---------------Lining material____._._________.._.---_.--___-_----_ ❑ Size: Diameter-------------------------------------Depth-----------------------------z---- x-------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest boding_-________.______-_______________.__..._- , ❑ Distance to nearest lot line---------------------------------- ----------------------y--`--`--------------------------------------------------------------------------- Remodeling and/or repairing (describe) -------------------------------=-----------------------------•--------------`---------------------------------------- -----------••------------------------------------•-------------------------------------------------------------------------------------------•---------------------------------- --------------------------------------- + --------------------------------------------------------------------------------------------- ------------------------------------------ ----------------------------------- {b I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 0 ordinances, to laws, and rules and re lations of the San Joaquin Local Health District. (Signed) -------- •- ut------ ----------- -- F----- - �_ caner and/or Contractor] Y r ' ---------- ---------(Title} E►-------- ----------------_._...------- B :--- (Plot plan, showing size of lot, location of syste i relation to wells, buildings, etc., can be placed on reverse side}. 71-1- FOR DEPARTMENT USE ONLY 49 APPLICATION ACCEPTED BY ---- - P7-.--0---------------- ---------------- DATE-------b 3 T ------------- REVIEWEDBY------------------------ --------------------- ...... DATE--------- BUILDING PERMIT ISSUED--------------•--------------------------------------------------- --------------------------------.- DATE-------------------------------------- - -------------------- Alterations and/or recommendations------------------- ------------------------------------------------------------------------------•-----•--------- - -------------------------- --------------- ---------•------------------ -----------------------•---------------------------------------------- ----------------------------------------•- ------------------------•-------------------•-----------------•-------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------------------------•--------------------------------------------------------------- - -•----------- --------- - - ------- ----------- --- -- ------ ---------------------I----------------------------------------------------------- ---- ------ ----------. FINAL INSPECTION :-- f�'t /� Date. 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13.59 31A 3-'63 F.P.CC.