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FOR OFFICE USE: � -__ _�_�_�- ,--- APPLICAT' N�FOR SANITATION PERMIT Perm -------- it No. Z- 3 ; , -,:(Complete in Duplicate) I . .�, Data Issued -------- ----�-----�� ------------------------------- ----- Vin_-_--._.- This Pea-mi'f''l:xpites 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 JOB ADDRESS AND L CATI > r� -•-' +.� Owner's Name ----- -a----------------------- -------------------------------- Phone------------------------------------ -..: ---------•------ -------------------------------------- ------- Contractor's Name -------------------------------------------------------------------------- ---- Phone............----_----------------- Installation will serve: Residence ®lApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ e 01 Number of living units: -- = Number of bedrooms _Z Number of baths -Z--- Lot size ______________________________ Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table -6 tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A- nardpan ❑ Previous Application Made: (If yes,date-------_-----------) No R?"-New Construction: Yes ❑ No FHA/VA: Yes ❑ No Zj__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank-, Distance from nearest well----------------'Distance from foundation--------------------Material-----------------------------.-------.--------- .. 14f No. of compartments--------------------------Size--------------------------------Liquid depth---- ----------- ---------Capacity---•------------------- Dispos4 Field: Distance from nearest well--..---.--.-.Distance from foundation_-/ /--------Distance to nearest lot ...... L Number of lines...... ......... Length of each line----> .----- . ----------------------------- 1' ----Width of trench.- Type of filter material_ (i` epth.of filter material--_-1 AW ---.--Total length-----��- ----------------------- J Seepage Pit: Distance to nearest well-------- ________Distance fr fc ndatIon__ Q_�-_-_.Distance to nearest lot`line-_,4 -----_ fJ Number of pits-------4--------------Lining material--. Size: Diameter._ --------_--- 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 lire------------------- - --------------------------------- ------------------------------------------------------------------- -- D Remodeling and/or repairing (describe)----------------`� 1 = -------------------------------------------- --------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ---------•--------=----------------------------------------------------------------------- ---------------------------•---------------------------------------------------- ff I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned �j --- r Contractor g )----- -•------- l��G2'� -- -- ---= --------- ------------------- ) By:_---------------------------------------------•---- ---------------- Lam` y'�� ----------------(Title)----49 " .............. (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -... -------------------------------------------------------- DATE------ REVIEWEDBY------------------------------------ --------------------------------•------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------ Alterations and/or reco mendations--------------------_---- -:-..___ " ` / ----- --- - ------/---V------------------------------------------------------------------ ------ -- --------.►mow ---- �. ------------------ ----------- ------• _----------------•----------------------------- ------------ -- --- ----- ----------ate._-------- - ------------------- --------------------------- ---- FINAL INSPECTION BY:...... '------------------=-------------- Date.. - f --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.P.CC.