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FOR OFFICE USE: --- - ---- - ---- ---.. -- APPLICATION FOR SANITATION PERMIT Permit No. Z ------------- ---------------- --------- (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 described. This application is made in compliance with/u ty Or ' ante No. 549. JOB ADDRESS AND)_0 ATION. -- --- ---`-- ------- ----- J �.. ... ------ Owner's Name......... = 1p--ct- - Phone.................................... - � Address--------------------- . Contractor's Name ' - ----------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence 0"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ._ _. Number of baths .1.... Lot size __ _ _ 4? ......................._...__ Water Supply: Public system E] Community system [Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date-----.------.-------) No New Construction: Yes $rNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest well.fj0M___ --Dlsta fr foun tl n ----.Material_ ! No. of compartments_________aZ-_._._._`.Size.�c_-j__,��Q___ lk4id depth-------J� cf- .-.-___Capacity_.. Disposal Field: Distance from nearest well_�l��_/-_T'Distance from foundation..J40-----------Distance to nearest lot�liae17>,'>_.__�... Number of lines------IT--- Length of each line.' ��y�_�1 .Width of trench--_-c __7 ._____.___.___._.. s-------- =---- `� Type of filter material.45Z---X- .__ epth of filter material__4�-------------Total length........J. .................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- r_1 Number of pits----------------------Lining material..•__-_-.._-___.-__-.._Size: Diameter-----------------------Dept h----------._..__.___.......__.... I� Cesspool: Distance from nearest well-________________Distance from foundation_____.__._________.Lining. material._.___.___..__:______:__._._____..... ❑ Size: Diameter-------------------------- -----------Depth----------•---------------------------------- .-Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------------__-•------------------------ ❑ Distance to nearest lot line----------------------------- ---------------------------------------------------------------------•-•----------------------------------- Remodeling and/or repairing (describe) --------------------------------------------------------------------------------------•---------------------- •-----� -----------------------•-------------------------------- ----------------------..------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, d rules and regulations he San Joaquin Local Health District. (Signed) __L--------/------ ____.._ --------------------------------------------------------Owner and/or Contractor By:------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------- ----------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- REVIEWEDBY-------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------—..................................... DATE------------------------------------------------------------- Alterations and/or recommendations---- --------------------- -------------------------------------------------------------------------------------------------- ------ ----------------- ----------------------------------------------------------------------------------------------------------------------------------------•--•-•--------------------------................................ ----------------------------------- ----------- ---------- --------------- ----------------------------- ---------------------------------------------------------------------------------------- � _� FINAL INSPECTION BY:. - --------- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED S-59 3M 3-'63 F.P.CD.