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FOR OFFICE USE: i - --- - -- ---- -------- --- ------ ----------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . //-: .f..._ ---- -- ----- - ----- -------------- (Complete in Duplicate) � Jam( ,� ______ --------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued - _ _�/f-1" `�- 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 LOCATI N __ _____ Owner's Name -------- -------------•------------ --- -------- ---------- ------------------------ Phone------------------------------------ Address `� . L_- -" -----rr------ ----------------------------- -------------------------------- Contractor's /Name--------- -------------- .0 - •-• --------x -----• - ------------------ Phone----------------------------------- Installation Will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/-_ Number of bedrooms -_ _ Number of baths ---/-- Lot size _GG__--4 �r..�_______________________ Water Supply: Public system El Community system ❑ Private Depth to Water Table/_�._-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 9 __ (No septic tank or cesspool permitted if public sewer is available within 200 feet. Setic Tank: Distance from nearest well------�� '_ Distancefrom i ndation____-- Material----_-(t _Kms________________________ p� No. of compartments------7�7------------Size_0 ----irXlLiquid depth-------ZI--------------Capacity-_l a - -- Dispose/Field: Distance from nearest well ---Distance from foundation-----/__2�_-___-.Distance to nearest lot line;_____________ Er Number of lines---------�_ Length of each line---------1_-V-.O.._.....Width of trench------�-_!------- _- f Type of filter materiaL___5t------------r__Depth of filter material------ .9'__-----__Total length----------- ----------------_ Seepa� Pit: Distance to nearest-welL___��_s-___Distance from foundation____ _____.Distance to nearest lotff lines ._._ Number of pits-----c.?----------Lining material-----S.OZ,,__.Size: Diameter____-7_.7-------- Depth__. 5-_._ ------------- Cesspool: Distance from nearest well----------_____Dita snc --_ e"from foundation--------------------- material--------.------------------.--------- ❑ Size: Diameter---------------- ---------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------_.__ -------------_--------___-Distance from nearest building----------._-____---__________--__-.___.-. ❑ Distance to nearest lo} line- ---_A: _-------------------------------i..-------==----------------------- I -xy Remodeling and/or repairing (describe):=------ --------------- --------------1- -------------------•-----------•- -----------•--------------•- ........ ----------------------------- ------------------------ ---------- ------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have repar d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r n er gulations of the oaquin Local Health District. (Signed)------------------------- ------- -------------------- ntract -- --- -- ------ (PlotIan, showing size of lot, location of system in relation to well ildin s, etc., as{bele]------------------------se side). p y g placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- -------------------------------------------- DATE----1 ' -�� `�. - -------------------------------- REVIEWEDBY-------------------------------------------- --------------------- ----------- ---------------------------- ------ DATE------------------------------------------ ----------------- BUILDING PERMIT ISSUED------------------------•---------------------- ------------•---------------------------------------- DATE------------------------ -- Alterationsand/or recommendations--------------- ----------------------------- ------------------------------------------------------------------==---------------------------------------------- ---------- ------ FINAL INSPECTION BY:.-.__��. I� --------------- Date �� 'CA_iS - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.CD.