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FOR OFFICE USE: f yL q 2. _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ...1. -S. ---- --- (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 County Ordinance No. 549. * -----------------------•-------------------------------------------------- JOB ADDRESS AND LOCATION. -----�--' + - Owner's Name ----- Cil. J•- --------- Phone----------------------- Address -------•------------------------------------------------ --------------------------------------------- n . Contractor's Name-------c �^?.--- `5 •7.3----- ----- Phone......... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I-__- Number of bedrooms -___2-Number of baths ___(__ Lot size ---1 /gQ•��S' I---------- Water Supply: Public system ❑ Community system Pit' Private ❑ Depth to Water Table /eft. Character of soil to a,depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay el- Adobe❑ Hardpan ❑ ---_.) No New Construction: Yes No FHA-/VA: Yes No _ Previous Application Made: (If yes date.-__- .- [�"� ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �r Septic Tank: Distance from nearest well-----------------Distance from foundation.II-- ------ .Mafe�ial-- �'`_--- --- No. of compartments--------�.--_-____-..._-Size.....s 6..X.`�___,_--Liquid depth.__---_-__________________Capacity...QQQ_o _P4 Disposal eld: Distance from nearest well ..'------Distance from foundation.�U_____________Distance to nearest lot ❑b/ Number of lines___.. . Length of each li 3.75.N(1/ th of trench..._¢_y__________________ - -- ----- ,r- r" Type of filter material.._I_-.o_C<?t-------Depth of filter eria...d---------------- otal length----AK ..................... 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_builsling_____________ ___________________---.... - ❑ Distance to nearest lot line---------------------------------- --------------------------�------------------------------------------------------------------------------ J Remodeling and/or repairing (describe):.......... GCS ^�K L/ -------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------- - -.......................................------------------------------------------------------------------------------------------------------------------------------------------ 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, nd rules nd regulations of the S Jo in Local Health District. t r (Signed)-------------- -- -- ------------ ----- - ---------- ----------------------- ----------- (9ano-aad{�or Contra�tor} �J ---•----- ----- ---•------ -• ----------- - ------------------------------- .............................................(Title).....--------------------------------------- - ------------ By: C� (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). Q FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY--------------------------------------------------------------- ---- . ---------------- DATE----------- ---..., - REVIEWEDBY------------------------------------------ -------- _----- - --- - _7 ------.-------•--- DATE------.... --------------.................. BUILDINGPERMIT ISSUED-------------------------------------------------------- ...._. -------•----------•-•---------•---- DATE------------------------------------------------------------ Alterations and/or recommendations------------------- --------------------- --------------------------------------------------------------------------------------------------------------------- ----•----------------------- ------------------------------•------------------------------------------------------------•-----------------------------------.----------------------•--------------------------•------------ ------------------------------------------------------------- -----.-...----------...-----------------------------------------.....------------------------•----------------------------------------------- ------------------------- ---------- --- -------- ----.. -- -- ------------------------------- ----- - ------- --- -- - --- -- FINALINSPECTION 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 95 9 REVISED S-59 3M 3-'63 F.P.CO.