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F 0,R OFFICE USE: - --- ---- ------ ----------WA------------------------------ --------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- -------------- --- --- (Complete in Duplicate) Date Issued _71 </�31 -----------------=------- ---------------------------- This Permit Expires I 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. ----------------------------- JOB ADDRESS AND LOCATION/, ------------------------------------------------ 4 2-3 f 7 ------------ --- --- ---------- ---- ...... Phone-A0-------------------------- Owner's Name---?11 '1. .-----`....--- Add ress-.--,;7,- - - -- ---------- - --------------- ------- Contractor's Name---------- -4;e---- - --- ---------- -- --- ------------------- Phone--------------------------------- Installation will serve: Residence ER"Apartmen House FE] Commercial E] Trailer Court E] Motel 0 Other Number of living units: --l- Number of bedrooms-4-. Number of baths Lot size ------------------------------- Water Supply: Public system E] Community system El Private 0 Depth to Water Table -4 Oft. Character of soil to a depth of 3 feet: Sand El Gravel Ij/ndy Loam E] Clay Loam El Cl;ayQ, Adobe [Hardpan ❑ 0 N r Previous Application Made: (if yes,date--------------------) N New Construction. Yes E] a FHA/VA: Yes El No ?To�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) se Distance from nearest well.................Distance from foundation---------------_.__.Material..-..-__-__-__-..._.........._._-____......._.... No. -----Material------------I------------------------ No. of compartments-------------------- -----Size---------------------------------Liquid depth-------------- ----------Capacity----------------------- Dis Distance from nearest well.................Distance from foundation-------I------------Distance to nearest lot line---------.-...._. Number ine------------ Number 'of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type. of-filter material--------------------------Depth of filter material------------ -----------Total length------------------------------------------- See Distance to nearest well---------------------Distance from foundation..............1._..Distance to nearest lot line-------------- Number of pits----------------------Lining material----------------- _---.Size: Diameter------------..----.----Depth--------------------------------- Cesspool: epth----- --------------------------- Cesspool: D;sfance from nearest weJ1-----------------Distance from foundafion------------�_'__.Lining material------------------------------------- 171 Size: Diameter--- -------------------_-- -------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest ----------------- --------------------------------Distance .from'nearest building------------------------------------------ ❑ Distance to nearest lot line--------------- -- r-------------------------------------------------------------------:-- -- ------------------------------- J. -4 Remodeling and/or repairing (describe): .. .. ...... j - - -- --------------------- ------------------- ---- ----------------=-----------------/----------0- ---------------- ---------- ------------------------------------------------- ---- --------- -------------------------------I--------------- --- - ----- ------- ...... . - --- -----_----------------- ----------------------- -------------------------------------------------------------- 7 .. . ............ ;-------------------------------------------------------------------------------------------------------------------------------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 re ns of the San Joaquin Local Health District. (Signed)-------------------------'----------- ------- ------------ ----------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------------- -------------- --------------------------------------------------------(Title)--.-- --- ----------------------- ---------------- (Plot plan, showing size of lotjocation of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMEYT UISE)ONLY —1Z DATE--- _4. .... APPLICATION ACCEPT --- ---------------------- DATE- -- --------- REVIEWEDBY----- ------------------------------------------- ---------------------- -- --------- ----------------------------- DATE------- BUILDING DATE------------- ------- BUILDING PERMIT ISSUED------------------- --------- Alterationsand/or recommenda+ions:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------------------------------------- -------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------- -------------------------------------------------- /-----------------= ------------------------------------------------------------------------------------- ----------------- -- -_----------------------- ----------------- ------:-------------------- ------------------- ---------------------------------------------------------------------------------------- ------------- ------------- ------------------ ------------------- --- - - ------------- ----- ---------- ------------ -- - -- ------------------------------------- - ---- ----- ----------- FINAL INSPECTIONBY:-_------ --- - - - -- ------ ----- ------- --- ----- Date_-.--- -------------- -- -- - --- --------------------- SAN JOAQU LOCAL H ALTH DISTRICT *k 1601 E.14azeltan Ave. 300 West Oak St eet 124 Sycamore Street 205 West 9th Street Stockton,California Loch,California Manteca,California Tracy,California ES 9 REVISED ct._59 .31A 3-63 F.P.120.