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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ................... - ------------------------ __ - (Coplete.in➢n_I]_rCate} a Date Issued _�/------/� ----' ----_--------------- ---- --- This Permit Expires-1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construtt and install the work herein described. w This application is made in compliance with County Ordinance No. 549. ^ JOB ADDRESS AND LOCATION----------------------- --------------- ---------------------•----------- Owner's ------- ----------------• - --- ----------------------------- Phone-.... Z --------------------------------------------------- - �l = --'---------•-------------------------•-••------------------••---------------- Address Contractor's Name_---F��T3/t�y----------------------------• ---------•-------- ------------------------------------------•------ Phone----------------------------------- Installation will serve: Residence® Apartment House F1 Commercial ❑ Trailer Court ❑Motel,❑Other [I Number of.living units: _-1-`_-_ Number of bedrooms _- ._ Number of Baths _j..... Lot siz�_._. _ i �--- =---------------------------- Wafer Supply: Public system ❑ Community system ❑ Private [b Depth to Wafer Table-f#—�''� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[� Hardpan ❑ Previous Application Made: (If yes,dote--.-_--------------) No New Construction; Yes,[ No ❑ FHA/VA: Yes ❑r No El TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool perrriitted if public sewer-is available within 200 feet.) Septic Tank: Distance from nearest well_�-�-------Distance from foundation-___-1_d-- ----.Material--- - --------------------- ----- ------ No. of compartments Size -----Liquid depth----- �`---------------Capacity-----�------------- h a S------------ Disposal Field: Distance from nearest well_�---_-.'.--_Distgnce from foundation___./--------------Distance to nearest lot line_-- __ 41 IVI Number of lines------ ------------ ----- -- Length of each line-------In----_----_------Width of trench._--�Y--.---------------.-.__ r ., ------Total length----f-rT----------------------------- Type of filter materia- Depth of filter materia!-_--�_ __-_-_- Seepage Pit: Distance to nearest well---/_fY -------Distance from oundation---��-----------i tan se to nearest lot line--. ----__-._ Number of pits.- - --------------Lining material-- �____---Size: Diameter------••--•-_---- Depth_. - --------------------- do ------------- - -- Cesspool: Distance from nearest well-----------------Distance from foundation_-_.-.-.-___--_-_---Lining material----.--------.----_----------------_-. D ❑ Size: Diameter------ -------------------------------Depth.--------------- ----- °--- -Liquid Capacity---------------------------gals. Privy: Distance from nearest well_-----------------------------------------------Distance from nearest building-----------------------_----------------- ❑ Distance to nearest lot line------- ------------------------- ----------------•---------------------------------------- 1 Remodeling and/or repairing (describe):------_-------------------------------------------------- ----------------------------------------------------•---------------------------------------- t ------------------------------------------------------ ----- ----------• •----------------------------- ----------------------•---------------------------------•------------------ ---------------•----------------•----------------------------•---------------------------------------------------------------------- -------- I hereby certify that I havelprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ules and regulations of the San Joaquin Local Health District. rel J f � ------------------------------------------(Owner and/or Contractor) (Signed)-- -r By:-------------------------------------------------------------------------- -_-------- -------------- -----------------Moe --------------------------- -------------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. .x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�BY.-. - - -- ------ -- ----------- - ------- ---j---------- -------------------------- DATE-----` ' 'CSS` REVIEWEDBY-------------------------�'`_' __ -.._ --=`------------------------------------------ DATE------------------------------------------------•---------- BUILDINGPERMIT ISSUED-------- ---------------- ------------------------------------------------------------------ DATE----------------- ------- ------------------------------ Alterationsand/or recommendations-------------------------------- -------------- ---------------------------------------------------------------------------------- -------------------------- --- .. -- ----- �' fes-- - -- ---- -�•-----�---- ��-��•-- - - ------ - { - J --1 -------- ---- -- --------------------------------- --------------- _2z/• -d--7- ---- - p FINAL INSPECTION BY------------- ------------- Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street.+ar 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California REVISED S-S9 31A 3•'63 F.P.CO.