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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. . .. ------------------------------------ ------------- (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 escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A L CAoTION _ -------- I� Owners Name = hone Address.---------- Contractor's ----•---Contractor's Aone----------- ------------- Installation - ---Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other E Number of living units:�('� Number of bedrooms _- _ Number o aths __ ___ Lot size _. I Water Supply: Public system El Community system El 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: (N -eptic tank.or cesspool permitted if public sewer is available within 200 feet.) - -` e pDistance�xromafounda tion____/d________.Mater'al'_._._- _________________________ Se tic ank: No of compartments. -----------------Size--- _.__ _ - ------ from depth____._.__ ..__.--_-. Capacity____ -- Dispos ieid: Distance from nearest well..e ®._..__.:Distance from foundation.____/�_______-.Distance to nearest lot line___________ Number of lines________ _________ Length of each line_-_10.d---------- of trench---.--" ! ------------ r Type of filter.material_____, rt___`Depth of filter material-_-,.__l�.____Total length----------'AQ-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________ Distance to nearest lot line---- ------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-------------------.---Dept h-.-------.-----------------____-- Cesspool: Distance from nearest well-----------------Distance from foundation---_._.---.__------Lining material--.--.__--:-___-__-_-____._______ ❑ Size: Diameter---------------- --------- -----------Depth----------------- ------------------- -------------Liquid Capacity-- ------------------------gals. Privy: osancerom..nearest we ____---_ ___________________________ e -"_ ---------------------------- -:--meq" ❑ Distance to nearest lot lire---------- ---------------------------------'------------------------- ------------------ -------------------------------------------------- Remodeling --------------- Remodelingand/or repairing (describe);--------------------- ------------------------------------------------------•---------------- --------------------------------------------_----------- ,r- ----------------------------------------------------•--------•-----•---------------------•-------------------------------------------------- ---------------------------- ------•- ------------------------ at I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la ,]and rules and regulations of the San Joaquin Local Health District.. Si ned --.._ nd or Contractor BY:------ -- ---------------------------------------------------(Title)---------------------------- -----------..----. ---- Plot Ian, showingsize-of-lot, location f_s ste relation-to wells,=buildin s etc.,-can be_ laced on-reverse side).-,.- �� I FOR DEPARTMENT USE ONLY - l APPLICATION ACCEPTED BY--- DATE_-c1� /'G �� P. - «. REVIEWEDBY --------- ----------------------------------------------------"-------------- DATE------ -----------: -------------------------------------- BUILDING .------------------------------------ BUILDING PERMIT ISSUED-------- _ - ------=-------------------------=---------------------------------- bATE. --------- ----------------------------------- . } . _ _ Z- Alterations and/or recommendations------------------ - -------------;----------------------------------•--------•-----------------------------•-_----------------------- ---------=---------•-----------------------------=--------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ .. Mqi ------------------------------------------------------------------------.-----------------------------•------------•--------------------------------------------------------------------------- ----------------------- i f 7 --------_--------------------- -----------------------------------------------_------------•------ ------------ d FINAL INSPECTION'"BY4 ---------- k, Date_----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ~p V 1601 E.Hazelton Ave. i t'; 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California `f st Lodi,California - Manteca,California Trac California � y, E5 9 REVISED 8.59 3M 3-'63 F.P.CD.