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FOR OFFICE USE: `# APPLICATION FOR SANITATION PERMIT Permit No. fP..L ,l.. -------------_--- - ------------- - T (Complete in-Duplicate) - --Date Issued _____ �_ This permit Expires 1 Year From Date Issued Application is hereb� 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 Coun Ordinance No. 549. �r JOBADDRESS AND OCATION-- -- ------------� -------- -------------------------------------- ------- ----------------------•- Owner's Namee . - ------- ------------------ ---------------------- --------------- Phone-- ----------------------------------- tAddress--------V/--- -•-----------•-------------••--••---- Contractor's Name - --------> Phone... .- Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.".4 Number cf bedr o ns ___ Number ' f✓baths _�-. Lot size .___.��.'_______ ______________ ___ ___________I Water Supply: Public system ❑ Communitysystem_❑,_larivate-{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,ldote--------------------) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: (Na septic talk or cesspool permitted if public sewer is available within 200 feet.) =.: Septic Tank: Distance from nearest well_______________Distance from, foundation--------------------Material---------------------------______-._.__:__._..___. No -------------------------------- �, . of compartments _____.____Size_____________________ _ __Liquid depth---------------- ----Ca acit _ ©ispos field: Distance from nearest well.--- ___.Distance from foundation-----IV-------Distance to nearest lot line____S_--------- ------------------------- Number _____-_ hh :___ __ Length of each line Width of trent '�__ _____________Number of.lines--------- g �j ----------........----. Type of filter..material----�_ � �-- Depth of filter material---._1.9-_ Total length.----•---------------------------`;----- X11 Distance to nearest well__� ------------- Distance from foundation_____/0------ D�jstance �o nearest lot line- ----•-- Distance - ❑ I'lumber of pits i____ __-----------Lining material__-_Size: fr3i er_ -_X__� ___.Depth____/y_____________________ Cesspool: Distance from nearest we'll_ ____._ _-_-_Distance from foundation............._.-__.Lining material__._.________-__.________________- ❑ Size: DiameterJ---- --------- ---- -------- .Depth " ------.Liquid Capacity gals. Privy: Distance from nearest well---------------------------_____________________Distance from nearest building.____...______________________..___..___. ❑ Distance to nearest lot line----------------------------------- 't--:- - , rr ------------------------------------------------------------•-- ---------- ' Remodelingand/or repairing (describe)=---------------------------------------------------------------------------------1-----------------------------• ---------------- ----•-------- i -----------------•---•------------ I----------------------- ------------------- ------------- --------------------------------------------------------------------------------------------------------------- --------- ----------------------------------- a -----------------------------------------------------r----------------------------------------------------------------------------------------------------------------------- ---------- I hereby certify that I have prepared this application and_that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules an ulations of the San Jog4uin Local Health District. (Signed)------------ ---------- ----- --------------- --------------t------------------------------ ---------�/or Contractor) { BY: ;- ------ --------------------� (Title) (Plot plan, showing size of lot, location of.system in relation'fo ells, buildings;. etc., can be placed on reverse side). , FOR-DEPARTMENT-USE QNLY 11 ------------------------------------------------- DATE--- - '63------------------------------ ` APPLICATION ACCEPTED BY- - ----------------- - - ----- REVIEWEDBY---------I----------------------- --- ---- -- ------ DATE------------------------------ --------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------- ------ DATE_------------------------- ---------------------------------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------•-•-----•----------------------------•-------------------------- ---•-•-------------------------1.:.------------------------•---•------------------------- -- -------------------------------------------------------------•---_---------------•---------•-•------------------------------ ---------=------ -------- -------- ------------------------Il------------------------------------------ -------I--------- ----------------------- ------------------------------------------------------------------------ FINAL INSPECTION BY -- - Date:_.._1...=d�" �b- - ------------------------------------------ A SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave._ 'r 300 West Oak Street .N 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California' Manteca,California Tracy,California { ES 9 REVISED B-59 3M 3-'63 F.PXQD Y