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FOR OFFICE USE: 7. ----------------------------------------------------- L/ --------------------------------------------------------- APPLICATION FOR SANITATION 'PERMIT Permit No. ../4... .....�� ------ - --- ----------- ---- ---- ---------------- (Complete in Duplicate).. , . /� 3 _ Date Issued ____________________ _._.____.___p�__---------------------_ __ __ ___._..__.._._ This Permit Expires 1 Year FromDateIssued Application is herebymade to the San Joaquin Local Health District fora permit to construct and install the work herein described. l This application is made in compliant th County OrdinP_., e N . 549. JOB ADDRESS AND LOCATION. D-�- -----------(,�(1 ---- ------ Owner's Name - ------ Address--- --------------------- Phone- -------------------------------- . ��d G , -- T o � - Contractor's Name------- phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ v�1 Number of living units: ________ Number of bedrooms _____ Number `baths -------- Lot size _________ __________________________________________________ Water Supply: Public system ElCommunity system r❑# Private Depth to Water Table -------- ft. i I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑— Sandy Loam Z/Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ N", Previous Application Made: {!f yes date._____- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4- `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance.from nearest well-----------------Distance from foundation--------------------Material ___________________________________-------------- El _ _______❑ No. of compartments----------- ------t---Size--------- ----------------- ---Liquid depth-----------__-- --------Capacity---------------------- Dispos Field: Distance from nearest well-----------------Distance from foundation------ _Q____._Distance to nearest lot lie___-------------- Number of lines--------- -- -------------- Length- of each line----- �'t3--------rr-- Width of trench-----..------ ----------------- ,Type of filter material----- c-v�� _.__Depth of filter material::__.__It________Total Eength--------1__0_ _ _____________ Seepage Pit: Distance to nearest well_-._.------------------Distance from foundation--------------------Distance to nearest lot line_____._._________ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter----------------------Depth______._______--_--- Cesspool: Distance from nearest well-__________-____Distance from foundation Lining material------------------------------------- ❑ Size: Diameter-------------------------- ------Depth---------------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------------------,__..-.-.___._ ❑ Distance to nearest lot line---------------------------------------------_-------------------------------------------------------------------------------I---------- --- + ��&earadeliTrt3—arr�}f�r repairing (describel:--------------------- -----------------------------------------•-------.-----•-----------------'------- •-•---------•---•----------•----------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- r 9 -------------------------------------------------------------------------•---------------•--•------------•------------------------------------------------------------------------------------------------------------ ---- -----------------------------------------.:----------------------------•---------------------------------------•-------------•---------------- --••----------------------------------------•--------- ------------ ---------� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SfaA laws, and rules d regulations of.the San Joaq •n Local Health District. r n (Signed} `'�^'r{-- ------------- [c�,..ro dor Contractor} BY:------ -------- ------------------------------------------(Title)--------------------------------------- (Plot plan, showing size of lot,.,location of system in relat n to wells, buildings, etc., can be placed on reverse side). t � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------ DATE--- REVIEWEDBY----------- '--------------------------------------------------------- ---------------------------------•-------------------- DATE.-------------------------------------------------------- BUILDINGPERMIT ISSUED--------------•---------------------------------- --•---•---------------------------------------- DATE------------------------------------ ---------------------- Alterationsand/or recommendations:------- ------------------------------------------------------------------------------------------------------------------- •------------------- ----------- ------------------------ ----------- ------------'------------------------------------------- ----------------------------- -------------------------•------ ---------------------------- - ------ -----•----------- -------------------------------------------------- - - ---------- -------- ------------ ---- ------------------ --- •- -._. .�?�7 . -��[•----- •----•-•---- ------------ �i FINAL INSPECTION Y..... ....... .... �._ --_ r .. ��/ /!_ � Date--.----- -----.- --'------- ---------------------------------------------- % SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave 00 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Cr Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 r'.p.l-"6, AA0ts