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FOR OFFICE USE: ---------- ------------------------------------- -------------------- ------------------------- -------------------------------------__--..__.__.____-----_.______------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. _:- ' ------------------------------------------------------ (Complete in Duplicate) „ --.---.-"--- This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work hereinidescribed, This application is made in compliancy with County Ordinance No. 549. -3 t V -3 D ATION.AbDE55 ANLOC ._ _ -- ._JOB --- -- __ 0 i Owner's Name C _.�` z '-G----'tlJ - -- Phone '` - Address---...------ / --- --- -------- - ----..._�._...-.----•---.--------------... ...-•-------------------------•_•Phone..---...---..----tt Contractor's Name------------------------------------------- �_ / Installation will serve: Residence ❑ Apartment-House Commercial .❑ Trailer Court ❑ Motel ❑ OtherE Number of living units..--/-:-.Number of bedrooms ________ Number of baths ____{__ Lot size __.____(-___ _.._t_________________________________ Water Supply: Public'system ❑ Community system ❑ Private [ Depth to Water Table _404t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy\Loam ❑ Clay Loam ❑ Clay Adobe ❑. Hardpan E] Previous Application Mads: (If yes,date___________________) No New Construction; Yes o ❑ )FMA/VA: Yes � No) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seer is available within 200 feet.) f Se tic Tank: Distance from.nearest well__ ___Distance from foundation---[-C�__------"Mpt�ial_____ _ �_�-a-�i-4----_---_. No, of compartments---- Size,7� _ _c`�-.----___Li uid de th____._____? � Ca aci � �� r � p W -- - - ---------- ------------------ ---------------- ------- Disposal Field: Distance from nearest well-;2e)/_�_.Distance from foundation _? �J p -- Distance to nearest lot linea__ t Number of lines_._.__-------___ -__-____Length of each line___:_____ _L�-_-�._�,__.Width of trench.-.__.. __,_ _______________ J� Type of filter material__ _T�",A Depth of filter material_______/K----_-_- Total length-----------1 _ '------------------ U� Seepage Pit: Distance to nearest well-____-----------------Distance from foundation__....--------------Distance to nearest lot,line__.____________-_ ---- Lo Cesspool: Distance frm nearest well Distance from foundation--------------------Lining materia----- 7 171 Number of its-----------------------Linin material------------------------Size: Diameter---------------_-------.De th---------:-__-: ❑ Size: Diameter----------------------------- ------.:Depth------- ----------------- ----- ----Liquid Capacity ---- ------gals. VY ' Priv `- Distanca from en crest wef----- --& ---------- -------- from nearest buildin ` y'� -------..Distance 9---- ------------------------------- la ❑ Distance to nearest lot line------- ---------------------------------------- ------------------------------------- ----------------------- Remodeling �l ----------------------------- ---------------------------------------------------------ibe- ---- --------- ------------- -------------_ --------------•-------------------------•------•--•------=--------------------------------------------------{and/or reairindescr -- ------ i -------------------------------------- --------------_ --------•--------.._..-----------------------------•-------------------------------------------------------------------------- -------- 9 q q ----------------- ---------------------------- -- -----------------------p---- --- -- -Rp---- ----- --- - ----------------------------------------------------------------------------------------------in County 1 herebycertifythat I have re ared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, andel rules/and regulations of the San Joaquin Local Health District. (Signed). ---�--- --------------------- =�• -----------`----------------------------------------- - SO ---- ------ Title......... f (Owner and/or Contractor) (Plot plan, showing size of lot, lo�tn�_oTtem,sysin-relation to wells, buildings, etc., can.be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_... ----�---------------------------- --•------ -------------------------- DATE__s -------- ---------------------- REVIEWED BY ------- ---------------------------------- -- SATE-- tr , BUILDING PERMIT ISSUED - Ef Alterations and/or recommendations: -------------•------=-=---------------------------- - •-------�••`Jl> -- -----------------'---------------- -------•--------------------------------- ------------------•---------------------- --------- �------------ - - -- •------------ --------------•-----.- ---------------- -------------------------- ---------- _---- ----------- ,i --- Date------- ------- - � �- ----------------------- ----------------- SAN ------- ------ - F1NAL INSPECTION BY:.. - l ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Wa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 95 9 1*rV$5KD 19.59 3M 3-'63 F.P.Co. "