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FOR OFFICE USE: ---------------------- ------------ / APPLICATION FOR SANITATION PERMIT Permit No. - -- ----------------------------------------------- (Complete in Duplicate) _............. This Permit Expires 1 Year From Date Issued Date Issued 142--l _ _f� ' J 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 OCATIO C61_1� `c lu - - - - - -- - - - - -- Owner's Name --- ---- ------ -------- ------- ----------- ----- Phone Address..........- I-------- --- i�� `�------------------------- r ---------- -- ------------------------------------------------------------- -------------------------------------------- ------------------- Contractor's Name___-__.. ___ 1:7 Phone_____________ ----------•-•----•----- ---------------------- Installation will serve: Residence 2rApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/----____ Number of bedrooms . Number o- baths Lot size __.____ _ __��____QhR_______________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I 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.) Septi ank: Distance from nearest well_____,___.__�.__Distance from oundation_.__1__P__--____.Materials aE'n - --------- -------- --------------------- Size--_ i��• z No. of compartments_-----�----- - �-----_-�'.- --.X-`�---Liquid depth--------------------------GapacitY--1c`�oa- - ----- Dispo Field: Distance from nearest well-SO .--_. .Distance from foundation------/_V----- Distance to nearest lot line_� --___-____- Number of lines-------- _____ h_-_._.____Length of each line-------/!?a_`_______-Width of trench----- Type of filter material_______�, _____ Depth of filter material------�_-`�-__ ____-Total length_____-_�_ _________________________. Seep e'Pit: Distance to nearest well.__---/04_------Distance from foundation-------Lv......Distance to nearest lot line______. Number of pits_______r_)--------Lining material---------- Size: Diameter------- r___Depth..................r_---__ Cesspool: Distance from nearest well-----------------Distance from fou ndation------------------- Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth-----------------:--*--------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_----------_---------------------_-------'._.,Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------- ° Remodeling and/or repairing (describe)-VI--------•- --------------------------- `-------------------.....----•--••-------•----------•-----••-•--•------------------------------------ ---------•----------------------------------------------------------- ----------------------------------------------- --- ----------------------------------------------------------------- ----•----------------------------------------------- ----------------------------------- --------------------- --------------------- I hereby certify that I 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 Loyal Health District, R Si ned �- --- �r Contractor ------- ---- -------- - I----- Title (Plot plan, showing size of loft, location of system in relation to wells, .buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _------•---___-- _ DAT E---,I&_'__� ----------------------------- APPLICATION ACCEPTED BY_ REVIEWEDBY----------- WIfA---------------------------------------------------------------------------- DATE---- - '-------------- - BUILDINGPERMIT ISSUED-----••------------------------------------------------------- -------------------------------------- DATE --------------------------------------- Alterationsand/or recommendations----------------------------------------------- -----------------------•------------------------------------------------------------------------•------------- --------------------------------- -----------------••----------------- ----------- ----------------------------------------------------------------------------------•-----------------------•------------------------------- -----•------------------------------------------- ----------- ------------•--------•------------------------------------------------ ---------------------------------------------------------------------------------------- ---------------•-------------------------------------------..---------------------- ------------------------- ------ ----------------------------....-------------------//--------------------------------------------------- FINAL INSPECTION BY:.. Date.... SAN JOAQUIN.LOCAL HEALTH DISTRICT 1601 E,kazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ry 9 REVISED 8-59 3M 3-'63 F-F.Ca.