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qq FOR OFFICE USE: - -- --------- APPLICATION FOR SANITATION PERMIT Permit No. ... z ----------- --------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a.permit toconstructand install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AI�4 LOCATION.. / Owner's Name---_-___- ----- Phone_/—O---1� Address------------- -- --- ------------- Contractor's Name - (1 _. -------------- Phone_ _---wi � - ,j Installation will serve: Reside a [ Apartment House ❑ Commercial' ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms __ -_ Number of baths _____I__ Lot size ____- _y_X__�_ __________________________ Water Supply: Public system w1community system ❑ Private ❑ , Depth to Water Table &5_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay:Lo&n ❑ Clay ❑ Adobe4fr-Hardpan ❑ Previous Application Made: (If yes,date____________________) No ff--New Construction: Yes E l-o ❑ FHA/VA: Yes ❑ No e--- TYPE --TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanis: Distance from nearest well_________________Distance from foundation--------------------Material _-___.._____________.______________.__________. , oprZe-------•----- -- `------------Liquid depth- ------------- --------Capacity-----------•----_- D(s �ieDistance fomnea est well./� .�,Dstance frorii foundation__ __�`- Distance to nearest lot Ijne__ r �__-_=_---. Number of Tines �'_-�`-Length of each line--------- Width of trench------AST- ...- Type of filter materia +r_ 9Depth of filter materiaL____(t�____ Total length_______________r _________._____ /--- 1.. Seep�a,g/e'PIt: Distance to nearest well__ _____Distance from undation__ Distance to nearest lot L� -- line___~__.-_ Number of�pits._____ _ j.: Lining material.-A T4-___Size: Diameter--_ -- ---------Depth____-_�� ` ._________ ' K Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____._._____-----_._.______________. ❑ Size: Diameter----------------- -------------------Depth----------------------------------------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well----------------------------------------------_---Distance from -nearest building ❑ Distance to nearest lot line--------------------------------------- " -------------------------------- 01 ------------------------------Remodelin and/or re ai (d *be): _____ , ' ------ ------- - - - - - -- -- C" . ----- - _ __ �. I hereby certify that I have prepared this application and that the work will be dorreifin accordance with San Joaquin CountXr ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , (Signed,)--=--- t ...................(Owner and/or Contractor) By:------------ n im . -•- --------------------------------- ----------------------=------LTitle)------------------- r (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f ,,mss FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 44; -------------------- -------------------- ------------=------ DATE------ ?e� \ REVIEWEDBY------------------------------------------------------------------- ---------------------------------------------------------- DATE------- BUILDING"PERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE Alterations/and/,or recomme ti ans:--------------- ---------•-• --------------------•-------------------------------------------------------------------------- -4/`r -�j - 31- -------- G .__a tt7 J -------•-•-•---- ------------------------------------------------------------------ ---------------------------------------------------------------------------------- ------------ -----------------------------•---------- -� 7 --------------- --------------------------------------- FINAL ----FINAL INSPECTION BY: T Date.. � -------- ------- ------------------------ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:ellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' ES 9 REVIGrO 8-59 31A 31 '63 F.p.CO.