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FOR OFFICE USE: �t . ---------------------------- --- -- { APPLICATION FOR SANITATION PERMIT Permit No. ... � i i (Complete in Duplicate) 7 Date Issued .... ---- - -------------------------------------------------- This Permit Expires 1 Year from Date: Issued i I / Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei escribed. This application is made in compliance with County Ordinance No. 549. od]f } JOB ADDRESS AND LOCATI ----------------------------_ONZ . -= '` F-- •• iL -• iOwner's Na ,�------------ -- -- ----------•--------------------------------- --P--h--o--n-e---------------------------- Address ---- -•--- - - .,Contractor's Contractor's Name ` "' r ----=----- -- -•--•-------•-------------------•---------- Phone_._.. Installation will serve: Res dente []—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.[]. Other Number of living units:_1�1_'-Number of bedrooms _1____ Number f baths _�_---_ Lot size _..__ ___ ___ ----------- ----_-.__ Water Supply Public system ❑ Community system ❑ Private Depth t' at Table _--__-- ft. . l Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy .Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ ' No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is a ailable within 200 feet.) Se tic ank: Distance from nearestrwe�:-a?�._.-Distanc -f a C r N - -_-_ _ e•from��foundation_.__L_ _.___-_.Material_____.._�Cl.1�c•�2,--�-------------------• p� No. of tom artments_----_.7 Size_ _f � .- �.___Liquid depth____�.--.-.._ Capacity Cf� Cd acit Op t DispI Field: Distance from nearest well....5 ------Distance from foundatlon--_`0�_....:Distance to nearest 1o1line Number of line's--------- Length of each lin e---------/9?P--_-------Width of trench_.iF_2. .-------------------------- Type of filter material__ _ ... ___._,___._Depth of filter material--------- -91_ ____Total lengfh_--___1_________ _____________________ Seepage�Pit: Distance to nearest well----------------------Distance from foundation-______-_---_--_-.Distance to nearest lot line----------------- 9 ❑ Number of pits----------------------Lining material._.__.___.----.:.-----Size: Diameter-----------------------Depth--------------------------------- 4 0 Cesspool: 1-` Distance from nearest weil-----------------Distance from foundation-_ -----------------Lining material_______--_-.-_-_------=•--:`_-_-- S ❑ c1f) Size: Diameter----------------- -------Depth----------------- ----------------••------------ Liquid Capacity----------------------------gals. Privy: r Distance from nearest well---------------_---------------------------------Distance from nearest.building.-_----._--__--_-____________.____..__... ❑ r Distance to nearest lot line-------------------------------------------- - ------------------------------------�-------------------------------------------------. 4 Remodeling and/or repairing (describe)-------------------------------------------------------------------:------------------- -------- --•----------- ---------------------------------- . i - ------------------------------------'- A I hereby certify that I have prepared this application and that the work will be done in accordance ith San Joaquin County ordinances, Sta ws, and rules°and regulations of the San Joaquin Local Health District. 9 _ (Signed) _w and/or Contractor) By:---- = --- -••- K-------- ------- -- -- -- 9t----------------------------------------------------------(Title)----------------- --------- (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be.placed on reverse side). v a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ----------------------------------------------------------- DATE--.//- -f ------------------------- F REVIEWED BY--------------------------- ------- --------------------------------------------------•----•---------- DATE-------------------------------------- -------------------- BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterations and/or recommendations:--------- -------------------------------------_ --- ------------------------•-------------------•- •-----------=---------•--•----- ---------------- --------- ---------------------------------------------------------TIN ---- -- ---------------- ----------------------------- ------ -- ------------------------------------------ - ------ - ---- -------------------- ,,.0 FINAL INSPECTION BY s r � /� ------------------- Date___.. '_�A .. ___--_.___..._______._____.._ ._ i 1 SAN JOAQUIN LOCAL HEALTH DISTRICT (73 1601 E.Ha:alton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street I Stockton,California Lodi,California Manteca,California Tracy,California 3 E5 9 REVI6E13 8•S9 3M 3-'63 F.P.CC. E y