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F R OFFICE USE.' A a t .3 } C - APPLICATION FOR SANITATION PERMIT Permit No. __•-. --------------- - ------------------------------------------- (Complete in Duplicate) / ' ae Issued - - ------- -- -------- ------------------- -- This Permit Expires 1 Year From Date Issued DtId 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. "kk' " r 1 ` JOB ADDRESS AND LOCATIO _o �.� -- f Owner's Name___ �,L„----------------------------------- � :- Phone Address---------------------------qz:�__jo -------------------------------------•---------------------------___----------•------------ Contractor's Name-..,` _______.._.�.7= - t�.c - ' l ----- _ Phone- Installation will serve: Residence �artment House ❑ Commercial ❑ ' Trailer Court ❑ otel ❑ Other ❑ Number of living units: '� N er of bedrooms .__ _._ Number of baths __�ot size __ - — Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _Soft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ be Hardpan ❑ Previous Application Made: (If yes,date_______________ ---) 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.) S is T k. s ante from nearest well_________________Distance from foundation--------------------Material--__._________._ No. of compartments------------------------- Ize--------------------------------Liquid depth------------- - - -------,Capacity D' osa field: Distance from nearest well_ Q3i .-_Distance from foundation___/,__0_._.....Distance to nearest lot line_-_�.", .� Number of lines__�1____ Length of each line___ ' i 9 . Q.- 'Width of trench -- ----------- Type of filter material I_ ---Depth of filter mat erial--------1_9_ff----Total length------------------_--------A f__-- Seepage Pit: Distance to nearest well_ _. _QUI. _ ___Distance from foundation--/A.-'x _____-.Distance to nearest lot I �ne _-_-_ Number of pits------.�____________-Lining material----/e��f--_--Size: Diameter.___ 32".--___Depth_. -5-.7__---------------- � Cesspoo : Distance from nearest well-----------------Distance from foundation___-----------------Lining material------------------------ `_________-. 0 ❑ Size: Diameter------ ------------------------------ Depth----------------- -------- --------------------------Liquid Capacity-----------------------------gals. Privy: Disfance from nearest well------------- ------------------------------------Distance from nearest building I ❑ Distance to nearest lot line-------------------------------------------------•--------------•----- RemodeSing and/or repairing (describe) -------------------- _ i.. --•--------------•-•--------------------------------------------- ---: - ----'_---- ------------------------ _--- ----------- - -__---- _ -- ------------------. -------------------------------------------------- . -- ---- . ------------ �rtl:�ir"� ------------------------------------------------------------- - - ----------------------------- ----------- --------------- ---------------------- ----------------------- --- I hereb certify that I have prepared this app ication and that t work will be done in accordance with San Joaquin County ordinances, t to la and r les and regulations of the San Joaqui Local Health District. t 1 a (Signed) u- ----- ---- ontract r]J ' By:----------------------------------------- - •------------------------------------------------- - ----- - - (Title}_ - - (Plot plan, showing size of lot, location of system in relation to w ` s, buildings, etc./an` be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- :.--_,?e r'�'--------------' ---------=--------------------- DATE------- `-" - "' REVIEWEDBY------------=-------------- --- ---------------------- -- - - ------------`""""r � __ DATE------------------- ----------------------------•----------------------- BUILDING PERMIT ISSUED-_._.. - ----------------------------------------------------------------- DATE---------- " Alterations and/or .- eco e4n.d. 5iytons------- -------- -" -,-----_ _--__ ---•-------- ---- _ --_-__ ----- - ' - •/ :-. _. .----- -_ ._ _�____- ______ _ _..__ _ � � -------------- :_. -V ------------- -------- ------- �l�t ---� G? -,. ••- • 4-- et� FINAL INSPECTION BY:. Date. .' Ile------" ------------------------ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.Ca. '� k