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FOR OFFICE USE: ��7 J ------------ --------------- ------ IT Pe S S. --------------------------------------------------------- PPLICATION FOR SANITATION PER rmit No. .. .........:.:...... ----- -------------------------------- --- (Complete in Duplicate) S Date Issued --------------------------------------------._.__.___ __ This Permit Expires 1 Year. From Date Issued Application is hereby ma a to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp p Y N . 549. dot a — —t e�+� This application is made(n com liance with Count Ordinance - y' t ' _..- ' _ _JOB ADDRESS AND LOCATIO � `_ �e-- 7--------------- --- --•------------------------------------ Owner's ---------- Owner sName- ---------- Phone----- ---_; -- -- -- -�Address---- - --_ ....... ----- ----- ---- ---- Contractor's I C� Name---- _... 4-- ----- _- ---------------- ------ Phone----------------------------------- Installation will serve: Residence 1211�'Apartment House ❑ Commercial 1❑ Trailer Court ❑!/Motel El Other [DNumber of living units: _ __-_ Number of bedrooms y Number of',baths -------- Lot size ____lr '�1�__.•�______________ _____________ Water Supply: Public system El system ❑ Private [Depth to Water Table -------- ft. A_� y e Character of soil to a depth of 3 feet: Sahel=[]'Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay Adobe [] Hardpan C3 i Prevous Application Made: (If yes,ddte.._ -___ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yves E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) i. Septic ank: Distance from nearest well_x_�'_,- ._____Distance from foundaion _Q___.._.Material------- _. _ ` _ ___-. No. of compartmems----__ ______..____5ize. Ctl� __ _S___Liquid depth--_____A/---.____._.___Capacity__ c` Oa Dispos Field: Distance ne&re' st well___-:.- -- Distance from dafrDistance to est lot ine ________ renchumbeof l -_Length ofInei/ Woft _ e, of filter material____:_ Depth of filter matenal___--__f _____ _ ----------Total length.___ _.-f QCL____________________ .rYP, f Seepa Pit:, LDistance to nearest well------- -----Distance from foundation___1_O........Distance to nearest lot line -..e.,..�,,.. _-r _„-. _ e ------------ .,... . _s 3 �--------------------- Cesspool - ---------- - �Number of pits______._-�__-_ _L'ining material___-�^� _ .Size: Diameter______�__d'-_.-___..Depth_._._..__ ._ Cesspool: _t Distari66'from nearest wdI1`_�'_____Distance from foundation__..__.__.____..,- Lining material---------------______________________. ❑ Sizer Diameter------------------ ------- ----------Depth------------------------------- ---------------------Liquid Capacity----------------------------gals, 1 Privy: Distance from nearest well------------------------------------------------_---Distance from nearest building------------------------------------------- 'r ❑ Distance to nearest lot line--------------=-----------------------------------------------------••-----------------------------------------------------------------------.-(R Remodelingand/or repairing (describe)--------- -- -- --------------------------------------------------•-------------------------•--------------------------------------------------------- -----------------------------------------------••_-•--------- -'------------- ------------------------------------------------------------------------------------------------------------------- -------------------------------------- ---------------------------------------------------------------=--••----•-----------------------------------------------------------•---------------------------------------- -------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- I hereby certif at I have prepared this application and that the`work will be done in accordance with San Joaquin County ordinances, Staf a . and rules and regular' s of the San Joaquin Local Health District. --•----------- --- ------ :--------------------------- --------------------------------- ontracror) (Signed) • ---- , 1 - -- ---- ---- - (Title) {Plot plan,-showing size.-of,lot,location of-.system-in re ion.-toywells, buildings, etc., can be_placed on reverse side). T _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ��° . . -- - ----------------- ------------------ -------------- --•--- DATE------ - 'S---------------------------- REVIEWEDBY--------------------------------------------------------------------------------•-------------------------------------------•- DATE---------------------------- ------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------ ------ ------------_-- ------------------------------ Alterationsand/or recommendations-------- --------- ------------------- ----------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ------- ------------------------------- -------•-- ------------------------------------------- ------------------------------------------:-------------------------------------------------------------------- -------------------------------------------•------- } ------------ ----------------- -------------------------------------------------------------------------•-------------------•----•-•-------------•------------------------------------------- --------------- i .- _ Date `'- FINAL INSPECTION BY:_--'- � �if- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Hazelton Ave. li 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.rD.