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F ROFFICE USE: 3 _ _ . -w- APPLICATION FOR SANITATION PERMIT Permit No.,'- -.-__r ._ - ------ ------------------------ ---------------------- 15 ------------------------ -------------------- -------- (Complete in Duplicate) Date Issued .-- ------------------------ ------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for.a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ) r � JOBADDRESS AND LOCATION........ 3- f/-' --•--• ------------------------------------•----•---•--••--------------------------------------- Owner's Name---/•/! -------------------------------------------------------------------------- ---------------------------- Address-------------- --•----------------------- ------------------••---•-•-•--------------- = -----------------------------------------,------------------------------------------------- Contractor's Nam --------------------------7 ------------------------- -----------------------=--------------------------- ---------------------- Phone----------------------------------- Installation will serve: Residence,[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1-.._ Number of bedrooms -3- Number of baths -_- Lot size --------------------------_--,---------_ Water Supply: Public,system ❑ Community system E] Private Er-"Depth to Water Table : ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote---------------------) -No ❑ New Construction: Yes ❑ No ❑ FHA/VA-.'Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic +ank or cesspool permi++ed if public sewer is available within 200 feet.) Septic Distance from nearest well-----------------Distance from foundation------------------_Material----------_----___-_._--_-__---__-_________---. Na, of compartments---- ------Size---------------------•----------Liquid depth----------- -------- Capacity -- Dispo Fi Distance from nearest well- -- --_--.Distance from foundation..14.............Distance to nearest lot kne...d ---__..- Number of lines ---------------------------Length of each line------��------------------Width of trench -�.`J�------------------------ x� ' Ko., /� Type of filter material- -___.----_Depth of filter maferlal_7 ----------------Total length= .--- ----------_-----:_-__-----__-- 1 Seepage Pit: Distance to nearest well--- --------------Distance from faun"dation-------------`--_-.Distance to nearest lot line--,__---____----_ ❑ Number of pits---------------------Lining material---------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Dista race from foundation-------------_-----.Lining material---------------.---------------------- ❑ Size: Diameter--------------------------------------Depfh--------------------- ----------------------------Liquid Capacity-. -------------------------gals. Privy: Distance from.nearest well--------------------------------------------------Distance,-from nearest building_-----__-----__-----__----_--------__-.-, �• ❑ Distance to nearest lot line-------------------------- - -----------------------------------•------ ----------------------------------------- --------- ' Remodeling and/or repairing describe]:__-_/ C ___c '`U -- ---•- --------------------------_ 'Z-•-- o----`t---------------- �- 1`' �t� I -------------------------------------- -----------------------------•--------------•----------------------•----- --------------- - ---------------------------- --------------------•--- -------------------Z --•--------------------------------------- ---------- ----------------------------------------------- hereby certify that I have prepared this a ation_arid tha+ the work will be done;in accordance with San Joaquin County ] ordinances, State laws, and rules and regulatia s o the S Joaquin Local Health District. (Signed) -----------------------------------------------------.----- Owner and/or Contractor By: t (Title) ------- ---- ------ -------------- Y = ---- (Plot plan, showing size of lot, location of system :in relation to ells, .buildings, etc.,-can 6e placed on reverse side). 1 FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------------- DATE----q-�7. ---------------------- REVIEWEDBY- --- ------------------------------------- ----------------------=----------------------------------------------- -•-•• DATE------------------------------------------------------•-- BUILDINGPERMIT ISSUED-----•--- I----------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------- -------------------- -------•--- ------•------•----------------------•---=------------------•---------------------------------------- - ----------------------------------------- -------------- ------ -------•--------------- ------------------------------------------------------------------------------------- ------------------------------- ---------- I---------•._-------------------•----•------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---------------:------------- ------------------- --------------------------------------------------------- -----------------•------•--------- --------------I--------------- - --- - --- ------------------------------------------------------ ----------------------------------------------- FINAL INSPECTION 13Y: /�. y ------ -- Date---- � -----�----------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.F{aselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California .. CS 9 REVISED 8-59 3M 3••63 r.P-Ca- f