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F OFFICE USE: --------------- A 3 / ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _-�_7t�. -------------------------------------------- ---- (Complete in Duplicate) 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-- ------------- -•--•------------------------------------------------ t Owner's Name-- Phone_._-.. Address------------•• " ------------------- ----------------------- ----------- -------- 44 0 V- Contractor's Name - ti?': ' � G '"s" -- Phone--- . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: __/-_ N ber of bedrooms - Number of baths __I--_ Lot size _ , ----- ___ --------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table G-U f+. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date_..................) No ❑ New Construction: Yes ❑ No R+--%9A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S!��jcj :� Distance from nearest well-----------------Distance from foundation--------------------Material---------------.-____.__--_-:______---__-_----. No. of compartments------------- - -----Size----------------------------•---Liquid epth--------------- ----------Capacity..-------------- ----- osa : Distance from near st well .___ istance from foundation.-A-V----_.Distance to nearest lot line___ Number of lines_______ ._4_ __..-_ Length of each line_ -//-° .fie---.Width of french_cr ------------------- c Type of filter material �C> ___Depth of filter material----.l. ---------Total length._____________________ _0--------- Seepage Pit: Distance to nearest well--t0-_yUr____Distance from jjfoundation---le_ ._...Distance to nearest lot line...-OF / 00 Number of Its-_--_f----------------Linin mate rJl --.--.Size: Diameter._. __.__- ------ Cesspool: - ` __-Depth_..�-i.�I A r 9 - I. ----------- Cesspool: Distance from nearest well--------_--------Distance from foundation.-------------------Lining materiaL_.----__-_____--------..-_-.-_____ ❑ Size: Diameter-------------------------------------Depth--------------------- ----------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well------------------------------------------------- from nearest building-------.----.._____________-.-.._.___---- ❑ Distance to nearest lot line----------------- ---------------------------------------------------------------------------------------------------------------------------- .5 Remodeling and/or repairing (describe):-------- ------------- ------ Y --------------------------------------------------------------- '1 ----- ---------•-------- ---------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesj5e la and r les and re ulations of the Sa aquin Local Health District. (Sigm \� -�--------- X �- -f a Contractor) ( g ---- ----------------- By:---------------------------------------------------------------------------------- - - -- ---------------------(Title)------------------- ------------------------ -------- (Plot plan, showing size of lot, location of system in rely n to wells, bu' iings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �7 APPLICATION ACCEPTED BY-- ------------ ---------------------•-------------------------------------------- DATE--------/ = --------- REVIEWEDBY--------------------------------------------- --------------------- ---------------------------------------------------------- DATE---------------------------------------------•-------------- BUILDINGPERMIT ISSUED-----------------•----------------------------------------------------------------- ----------------- DATE------------------------------------------- ------------- --- Alterationsand/or recommendations--------------- -- - ------------------------------ --------------------------------------------•-•---------------------•-----------•------------------------- �---------------- ----------------- ----------------------------'-------- ------------------------ - -------------------------------------------------------------------------------------------------------------- ------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ OO f Date. . ~(`J�r� - ---------------------------------- FINAL INSPECTION BY:------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th S+Teet Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVfs£O 6-59 3M 3-'S3 F.P.CQ: