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FOR OFFICE USE: � oo,3 RacyN I'�J Ll Z lP x - -- ------ Ar APPLICATION FOR SANITATION PERMIT Permit No. �.... __. ---- --- ------ (Complete in Duplicate) S� ------------------------------------------------------ This Permit Expires 1 Year From Date Issued 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 CATION., 4_-----13 - ------- -� -r�urs_.. =-•--------- Owner's Name' _� ( .f Phone•-••••• ri -_.. Address -------------•---- ------------•-----•-•- Contractors Name------...... . = Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Q Number of living units: __L----- Number of bedrooms ----.__ Number of baths ----/. Lot size Water Supply: Public system ❑ Community system A 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,l New Construction: Yes 71 No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Distan fr foundation_-_ _A�-__---_. er' I___ '�`_` `-'_ --------------- fc Tank: Distance from nearest well_____________ p No. of compartments--___._ `__..__._.Size , ' _�..___Liquid depth_.. rl -__._Capacity___t --- DVI Field: Distance from near well-_._.__.._._.----.-Distance from foundat•on_-�-_--- -Distance to nearest lot li e_ -S of lines....... __----- _ Length of each liner_ __ Width of trench.._= --------------------- Number ----- --- 4� Type of filter materia-_�?___�__t.D—6epth of filter material._./__9______--.-Total length_._.._____r7 G:.-__._•_________________ Seepage Pit: Distance to nearest well--------------_-------Distance from foundation....................Distance to nearest lot line_--__._--____--__ V\ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------..._-.----Depth---------------_............... '3" Cesspool: Distance from nearest well-----_____-----__Distance from foundation--------------------Lining material-------------------------------------- 0 -__-___._--_-_--_-_---:_--_-__--__ .❑ Size: Diameter--------------------------------------Depth--------------------------------------- ------Liquid Capacity----------------------------gals. _A Privy: Distance from nearest weir-._:-_: .--------_-- --------__.__:_ ___Distance from nearest building._-_____________---------------------- Distance ____________________Distance to nearest lot line---------------------- Remodeling and/or repairing (describe):------ �.� � /-=--•--•--••----------------------------------------------•-----••--------•---•-------- -•---•--•--------------------------------------------------•- l/ --------------------------- ------------------- -�'�. --- -• ----- -- -----------------------------•-.----------------------------- - cA 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 Local Health District. (Signed).-' `L 2 _ Lt_- - -----rift-.-_-._----._ -------Owner and/or Contractor (Plot Ian, showing size of lot, location o Title { f - ----------------------------------------------- ( p g f rri m relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------------------------------------------------------------------------------------------•- DATE--------------_--------------- ---------------------------- REVIEWED ------------------- ------REVIEWED BY ATE -. BUILDING PERMIT ISSUED ---------- --- � --- DATE----fi----------- - - Alterations and/or recommendations:................................................. � _ .___ -------------------------------•------ ----------------------------------------------------------------------------------------------------------------------------------•----------------------•------------------•-------... --------------------------------------------------------------------- ------------------•----------------------------------------- --..._.._.....-----------------------•--•------------_------------------------------- ----------------- ---------------------------------------- -----'- ------=--------- --------------------------------------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY:---------- ----------i��- `--�'" � ✓? - --- ---------------------- 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 ES 9 REVISED 8-59 3M 3-'63 F.P.CC.