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-FOR OFFICE USE: �pjo�7 L�Z ---------------------------------- -------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...1...J?... _... - ---------------------------------------------------- -- - (Complete in Duplicate) f 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_S.C'=-----�_&A.. .........-........... ----- Owner's Name 4✓L -,4 -4;. { - - Phone Q Address.............................................Z........... ...... �___-----l. ---------- ------------------------.-----.------_---_--------- o _ Contractor's Name R-��L CCL,a'�j•....................•--- ---••----------•--•---. Phone.-�eft....3 fT.t._ S Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I.--- Number of bedrooms ---I--- Number of baths -----(_- Lot size ----- ......_----•.-•-_---.•-______ Water Supply: Public system ❑ Community system R, Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay a Adobe❑ Hardpan ❑ � Previous Application Made: (If yes,date-----------_-------) No ❑ New Construction: Yes 4 No ❑ FHA/VA: Yes E] NoR Z 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..... '----Distance f om fou d tion------I.-I---.Material. ------ No. of compartments-.-------0L-------------Size..4/2- from I/ t..Liquid depth--.--1.YZ.---.-_-.Capacity.-- �- Disposal Field: Distance from nearest well.-�------Distance from foundation..j4.1-------....Distance to nearest lot line--,5-.l....... G Number of lines----- ...---_(---------------------Length of each Fine-------FO----------------Width of trench.-_-_? Type of filter material---�s---��_Depth of filter material-----4�__-____._--_Total length.----- ___.:.___.,..•............... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--...._-__-__-_.. et 171Number 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----------------------------------.------. v ❑ Distance to nearest lot line------------------------------------------------------------�------------- ------------------------------------------------------------ Remodeling and/or repairing (describe) -----`V ------- ca�r"--------------- ------------------------------------------------------- -------------•---------- .......... ------------•-------•-----------------------•-•-•----•-------------------------------- -------------- -------------------------------••---------•••---------------------------------- ••---•...................-•-------------- ----------------------------------------•--- ------------- N ------------------------------------------ ---------------......------------------------------------------ --------------------------- --------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County J ordinances, State laws, and ruIps and regulations of the San Joaquin Local Health District. ------------_.9—erand or Contractor' (Signed)------------ -�-- - -�----;---------...-.-_...---------------- -------------------------------------------------------------------------- ( / ) By:------------------•--•-•-•••-------tt----------------------------------------------------------------------------------------------(Title)---------- ----------------------------- _---------- ------- (Plot plan, showing size of lot, Iacation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY sem`- ` DATE ��- - - 5--- REVIEWEDBY--------------------------_ ------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------- .......-------------------.................... DATE------ -------------•----------- .................. Alterationsand/or recommendations----....------------------------------------------------------...--------......................................................................---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------•---•----------------------------•••-•-------------- ------••- - -----------------------------------------------------------------------------------------------------------------------------------......-......................................................--••••-•-•----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ .......------------------ --------------------------------------------------------------------------------------------- ----------------------------------•-----------/----------------- --------------------- --- . It- FINAL INSPECTION Date. CO-- a .. �' S 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.CD.