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FOR OFFICE USE: i --------------------------------------------------------- APPLICATION FOR SANITATION PERMITPermit No. -1-a....... ------------ -------------------------------------------- (Complete in Duplicate) y 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 andi install the work herein described. This application is made in compliance with County Ordi nce No. 54,7. �i / , JOB ADDRESS AND LOCA ON Owner's NameLJ -........ u ®� -`��------ - ------\.......---- -------•----•-----------------•-----•-----•-•-------------------•------------••------•_.,-----._. Phone.................................. Address--------:�L��------_._ __ Contractor's Name------ -----------•------ ------------------------------•-----•'"-------- Phone----------------------------------- Installation -•---- - - -----------•------------ -----�- Installation will serve: Residence ❑. A ment House ❑ Commercial ❑ Trailer Court ❑;; Motel ❑ Other ❑ �i► Number of living units: Numb r of bedrooms _1_ Number of baths ___1_ Lot size _ _.�+'I��`•---------------------------- f Water Supply: Public system ❑ Commu . ystem ❑ Private 112-'15epth to Water Table-40-`ft. Character of soil to a depth of 3 feet: Sand �ravel ❑ Sandy Loam ®Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date__.____. __. t_ _.) No New Construction: Yes ❑ NoFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIO t (No septic tank or cesspool permitted if pub'C4 werjs available within 200 feet.) i S ttic.T nk:- Distance from nearest well----------- _ istance from foundation--------------------Material-_____-_____-_____-________-.-•________-_______- 4 rllgi No. of compartments---------------------- ize----- ---------------------Liquid depth-iw---- Capacity----------•----------- _____. XD• posal Fi{e4 Distance from nearest well:_._.__ istanc fr tr�atioe _- '�___��____-____. to nce..to nearest log V Number of lines------ .----- ------- ---- -ength of each line-------•-e-0- ___.___.Width : tr ch__ .-/--------------------- f� Type of filter material -f„ ---------Depth C r - e z ! Total le ----- s -_________________________ eepage Pit: Distance to nearest well----_-_--------------Distance from foundati --------- ='_.Distant to n t line-____________-._. �l y ❑ Number of.pits-----------------------Lining material---------------------- Size. eter- i-------------- -De ----- -------------------------- V Cesspool: Distance from nearest well--------.--------Distance from foundatio _ - --------------Lining, ' rial------------------------------------- El Size: Diameter------------------------------------ Depth-------------------- --------- ------------ ---&--.V I apacify-----------------------------gals. Privy: Distance from nearest well---------------------------•.-..--.-------------Dis��n; ror r rest buil ng------------------------------------------ [] Distance to nearest lot Eine r� ----- -`x'--•--------------•-------------------------------------------------- Remodeling and/or repairing (describe):---------------•---:-- `-- I--- ---- ------------------ ------------------------------------•--•---------------- w ------------------------------------------------------------------ --- ------------------------ ----- ---------------------------------3------------------------------------------------------------------------------ ------•------------------------------ F -- hereb certify I have --re prepare this a cation and that the work will be done iri acco-------------------------------------------------------- I _clan_______________________ _____.____________ -- y y p p p `rdance with San Joaquin County ordinances, State laws, and rules an re ulations the San Joaquin Local Health District. r F- ---- ---- (Signed)---------- -- -- ------------- - ---------------------•- (�or Contractor) i + ------[Title] �alr� ' (Plot plan, showing size of lot, location of system ' r ation to wells, buildings, etc., can*be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` --------- ----------- ---------------------------------------- ----------- DAV ----G/-------------- REVIEWED BY----------------------•--------- I-------------------------------------------------------------------------------------- DATE --------------- ------------- -•---- BUILDING PERMIT ISSUED---------------------- -------------------------------------------------------• ----------------- DATE.---- --- ------------- ---------------------------•-•---•----- Alter tons and/or recommendc�fions:-----------.------- ------ � _ - r w =�------------- ---- - SCS- 1 �, &-Z- ------ --'-`- G `' Vi' '` a "" �7 J---•--- s�-� .... --- ---- ------- ------------ 1.2._(a ,_._ � y� ----- ----------- f cJ srt � �j FINAL INSPECTION BY:. -------------------------- Date--- -------/------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street { 124 Sycamore Street 205 West 9th Stree Stockton,California Lodi,Collfornla 4 `� Mdoto' Callfornla ;1, �4 Tracy,California C6•9 REVISED 9-59 F.P.DD.2M 6.60 e