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FOR OFFICE USE: IIMoo -------------------=----------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. ... sPy '.. ------------------------------------- ------------------ (Complete in Duplicate) Date Issued ---1l 1-ry. - -------------------------------------------------------- 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 wiith�County Ordinance No. 549. JOB ADDRESS AND LOC TION.._.,! ` ' ------------ Name - --' -- � ��C _'�Gl --' - ------ ---------------------------- Owner'sl / Phone...... Address............6 ..1. �- Contractor's Name--- 3G �. - Ph .................. Installation will serve: Residence0--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J----Number of living units: ----t`_. ----- --Number of bedrooms --- Number of baths __l__._ Lot size ----- --______•--------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table __7_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ndy Loam ❑ Clay Loam Clay 0< Adobe ❑ Hardpan Q g c� Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Ey 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 ta.4)_. Distafrol at�i n.- _-1__�_____.M�aerta�l __,�__ ' 1`--.-_-_-_-.No. of compartments--_.-—I-- _-._-_ .Size ' _�`__� S Liquid depth__ -:. _<= Capacity./�.t14.... �� Dir oral Field: Distance from nearest ell-_ Distance from founds o'_ . ....__.Distance to nearer lot�inve.__-�_�___._--- Number of lines............. -._Length of each line ...__ .._-_ �� i�of trench._%'-c _,_-_-__-_-__-______--_ --=--------------- Type of filter material._,j__-�-e'�*-- Qepth of filter material--- ----Total length..........X j; ---- ------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation__--____-____--__.Distance to nearest lot line-_-_---..._--.... ❑ Number of pits----------------------Lining material---------------------..Size: Diameter-----------------------Depth-..------------------------------ 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 line------------------------------ ---------------- ---------------••---------------------------------•-------•----------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- 3 ----------- ---------------------------------------------•-------------------------------------------------------- -- --------------------------------------------------------------------------------------------------------- I hereby certif that I have prepared this application and thatALal, ill be done in accordance with San Joaquin County ordinances, State S. jad rules and regula�ns of the San Joaqalth Distric+. (Signed).. -- e � ~.AZ4 ------- ------- --(Owner and/or Contractor) By:.....................................................................................----------------------------------------------(rifle)------------------- ----------------------------- -------------- (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 APPLICATION ACCEPTED BY-------------------------------- ----------------- -------------------------------- DATE- REVIEWEDBY-------------------------------- ----------------------------------------------------------------- �f�.` DATE_ ------------------------------------------. . . . BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ---------------------- DATE------------------------------------------------------------- Alterationsand/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 195 9 REVISED 8-59 3M 3-'63 F.P.CO.