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FOR OFFICE USE '�-¢- -1` ---------� ----- APPLICATION AOR SANITATION PERMIT Permit No. _ ! ------------- -------------- (Complete in Duplicate) s This Permit Expires 1 Year From Date Issued Date Issued---_-- Application is hereby made to the San Joaquin LocAl Health District for a permit to construct and install the work This application is made in c m liance, with County Ordinance No. 549, JOB ADDRESS _-•, Owner's ----'-P--h-o-n-e--'-----LL-O ------ --------------------------- Address -----•------ Address-----------------_ ---------------_----------- - ----- -- �� -- - ---------------------------------------------------------_--------------Contractor's Name___ 1 ' -------------------------- - --- •-•-----. Phone--••---•-- • --- ------•- --- ------------------------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: -----/ Number of be.droomsi___, Number of batlis e/-__ Lot.size ________________________ Water Supply: Public system E] Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:# Sand ❑ Gravel ❑ Sand E] ly�r Loam E] Clay Loam ❑ Clay E] Adobe ardpan ❑ �, _�Yi/�-�. Previous Application Made: (If yes,date____________________) No New Construction: Yes No /VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------_______-----Material No. of compartments Size C - ------- Field: ------ f y( Field: _ _ . ._ . p - ------ ----- - ----------- apacty--_---- ---------- ---i--------- �Das Disposal Distance -est wet _._. _G"Distance from foui. DistanceonearesoneD_ -_.-------- Length of each line__,/G _-________ 1n s {LIV' - - : dthtrench.material_____$_ -------------- of {alter material___ _& ---.Total length ------ Seepage itistance to nearest wellDistance from foundation umber of its___ : _..._ Distance to nearest lotline__-{ _ __ _____________ Liningmateria Cesspool: Distance from nearest well--------------_Distance from foundation---------------------_Lining material------------------------------- .. ❑ Size: Diameter-----------------------•-----------rDepfh--------------------------- ---------------------------Liquid Capacity---------------------- ---:gals. - Privy: Distance from nearest well-------_ ______________ _______.._____ ._-__-Distance from nearest building ❑ _ _ Distance to nearest lot fine------ --------------------------------__--- _-- .� � Remodeling and/or repairing (descriL)----------------- -- z ---_--__ f -------------------•-----------•----••-------------•------ ---------•------•--------------•---------------- ----------------------------------------------- -------------------------------- .---- I - ------------------AP--------------•----- ------ I hereby certify that I have preptired this application and that the work will be done in accordance with San Joaquin County ordinances, State, s, and r and of the San Joaquin Local Health District. (Signed)--- (� - By: - --- --------------- --------- -__-_- (Owner and/or Contractor) ---- - / /,� C , = ------------ �'f- {Title _ (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., canbe pla��3_ overse id FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-------- ` � -------------- ------------------------------------------------ DATE--------BY DATE BUILDING PERMIT ISSUED____-- ! -- ---------------------------------------------------------=----------------- - -------_- ---- _ ---- ------------------- •— D Alterations and/or recommen tions:__ f_ A --------------------------------- ----- ---------------------- -------------- ------------ - ---------- ------------ ------------------- ________________y- _-_ --------- �. ., �-/ --- - ---- ------------------- ------------------- ----------------- ._ ----------------------------------------------------:-------------- FINAL INSPECTION BY-- -------------- ------------------ Date--------- `SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-$9 3M 3-'63 F.P.CO.