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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ��6� •--- ------------------- - --------------- (Complete in Duplicate)------ Date issued '.- .._r � _____ _ --------------------- 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. Q� 2--L-)60— 12-_ LA�lq --- ----------------n ------------------- ----------------ESS AND LOCATION_____ ------- ---•- ' 1� ------ Phone_ Name 1 � .. -- ( 4�k�{ fU ----------------------------------------••-•------ --------------------- Address ---- ------• - Contractor's Name----------•-------�----- ------------- -------------- ------------------------------------- Ph one-------•-_-------------•---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial frailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ......._ Number of baths -2__ Lot size ----- ---------------- Water Supply: Public system ❑ Community system ❑ Private [2-16epth to Water Tabie fd...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 [;�7 New Construction: Yes Ea--No ❑ .FHA/VA:Yes ❑ No [ ' ' YPEYOF'INSTALLATION AND SPECIFICATIONS: T (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well___I ____Distance from foundation__..�0._________.MatPial___.._______________"._------------------------- Septic __.____"_f`J_ _. Li Liquid de th-----""�A_I---- ---Capacity----.V- ------ El— No. of compartments--------____ - Size--y �``--- -=- q p. Dlsposal Field: Distance from nearest well----k��U_-Distance from foundation-----/--------.---Distance to nearest lot lina___.S.___.____. .i 4 Number of lines----------62 --------Length of each line---------S-! -------Width of trench--------�- --.--------------------- Type of filter material__1lout--------Depth of filter material---.--'`lr---------Total length--------- "d------------------- I Seepage Pit: Distance to nearest well__" ___-_Distance from foundation--------------------Distance to nearest lot line----------------- T I ❑ Number of pits----------------------Linin aterial----------- -----------Size: Diameter-------------- -------Depth---------- ------------------ t p ------.Lining material---- -------------' Cesspool: Sized Diameter nearest well==-___'= Distance from foundation._"-_- Liquid Capacity-------------------- -------------- Privy: .De th-------- - ----------------------------------------- s Privy: Distance from nearest well _--.------------------------------------------Distance from nearest building------____.-________---.-____."_..__ -; ❑ Distance to nearest lot line------ ---------------- - ----------------------------------------------------------------- a,., . . Remodeling and/or repairing (describe):------ --- ----------- ---------------------------:--------------- --------------------------------------------------------- -----------•--------------------------------------------- --------------------------------"------------------------- --------------------------------------------------------------------- ---- ----------------------------------------------- -----,---------- ---- I hereby certify that 1 have prepared t is a plication and that the work will be done in accordance with San Joaquin Count Q ordinances, State laws and rules and re ations f the San Joaquin Local Health District. . (Signed)---L � ---- -- --- ----- - ----- ------- ----- ---- e.,....a „� .____ -(Owner and/or Contractor R...� ,�...�.M...:r y:--------------_� � ---------------------------------(Title)-------------------- --- -------------------- -- -------------- (Plot plan, showing size of lot, to ion of sy in relation tow s, buildings, etc., can be placed on reverse side). FOR DEPA MENT USE ONLY 77) - ----- ------------ DATE----------C7:/946---------- ----------5----------------- - APPLICATION ACCEPTED $Y_ ____.___.""."__ _ ... REVIEWEDBY.------------------------------- ------- DATE--- ----------"------•--------------- ----------------- BUILDING PERMIT ISSUED----------------------------- - --- DATE Alterations and/or recommendations:---------------------- --•--•----•-------•----------------•-----------------------------_ ------------------------ ---_ ---------------------- ------------------------------- --------------- /-- -- - --------------------------------------- -- __ ------------- -------------------------------- ----- ----------------- -------------------- ... ....It----------- ------------------------ -------- FINAL INSPECTION BY------ - --------------+------------------------------------- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.a.C o.