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FOR OFFICE USE: ' i � -------------------------------------------- ------------ ` APPLICATION FOR'SANITATION PERMIT Permit No. i ----------I--------------------I------------------------- {Complete in Duplicate) I/ / ---- - -= ---- ----------------- -------------- -- This Permit Expires 1 Year From Date Issued Date Issued __/- 1_-f---�. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here*y described. This application is made in compliance with County Ordinance No. 549. I h ,r JOB ADDRESS ANLOCA ION _ Onz,_ el- - ` ---- ------------------ _-44--- INN— _ Owner's Name____ Address Phone - ---- - -- - - --------------------------------------- .---------------------...---•---•--- �. 4`4----- - = -� f � Contractor's Name------.-- �:�. . .------••---- ------------ -- - ----•• ----•------ ------------------------ ------------- ----------- Phone---------.__...---------•--•---..._ Installation will serve: Residence Apartment Huse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.__._- Number of bedrooms -,Z- Number of baths OL—Lot size --------- 5Z41 T- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table_______ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam p ❑ ❑ y n` Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------_---_I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well_______________ Distance from foundation_-____________-_----Material___._-_.________.______-- F Dispose leld: Distance _from nments ----Size Liquid depth --------Capacity.__ - ❑ No. of compartments w y Barest well Q___.,_._..Dastance from.foundafion-__-//6 Distance to nearest lot line__•, Number of lines-------------- Length of each line_______- ---- . 9 �-a--------- ---Width ofType of of filter material______ -----Depth of filter material-------x9_4_---.Total length-----------4_d`-.f____---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------.---------Distance to nearest lot line-:- ------ ❑; Number of pits'--------------------Lining material.----------------------Size: Diameter----------------_. _ Depth--------------------------------- ! Cesspool: Distance from nearest _Distance from foundation-------------______.Lining material--.----------------------------------- ❑ Size: Diameter----- -------------------- ----------Depth------- ------------------ ---f-------------------- #-------- -------.--Liquid Capacity...-------------------------gals. Privy: Distance from nearest well------------___'__________I--------------------._Distance from nearest.building _____________._______ f - J> ❑ Distance to nearest lot line---------------' .� ----------------------------------------------------------------------------- s 4) w- Remodeling and/or repairing (describe:_____ _ i - -------- -----•----------- -------- J -- - = `"__ ---------------------------------------------------------------- --------------------------------------------------------• --- I hereby certify that I have prepai8e 1-+his:application and that the"Work-will be done in accordance with San Joaquin County f ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- -I -- t` -------------------------------------------- (Owner an Contractor) - - ---- ---- --------------------------- ---------- ---- ------------------- Own dor' 8Y= = -- - `•------ (Plot plan, showing size of lot, location of system in r ation to wells, 6uildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _._._ - ___--_______ DATE--- "_ ' _G REVIEWED BY---------------"------------------,`--------------------- - DATE---------------- BUILDING PERMIT ISSUED-------------',-*--------------------- - --- ---•-- DATE - Alterations and/or recommendations_____________._..__._._ ------- -------------------------------------- ------------------------ -------------- FINAL INSPECTION BY:/'"� __ "� x-w ---. ---- Date--- ---- --------- ------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California £ C9 9 REVISED 8-59 3M 3-'63 F.P.Co. r