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FOR OFFICE USE: ----------------------------- ------------------------ - ------------------------------------------------------ -- APPLICATION FOR SANITATION PERMIT Permit No. ....... �..../. -------- ----------------------------------------- (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 N . 549. S =- •1- JOB ADDRESS AND LOCATION -- ------------------- Owner's Name-------- ag -T -� -, "." ��+ � +�s�--------- . = Phone. r� A- -------------- Address------------------------- -- '. ` Contractor's Name----------- ,PA-- ----- -4 ------ Phone" f '_ 7_ Installation will serve: Residence $,, Apartment House E] Commercial E] Trailer Court ❑ Motel El Other p ry Number of living units:'-----_ Number of bedrooms _ --- Number of baths - ----- Lot size ----1 --- __- `.----_-_.._.----.--- Water Supply: Publicfsystem.;❑ Community system ❑ Private Depth to Water Table -104ft. Character of soil to'a depth of 3 feet: Sand K Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: ilfyes,date.--------------------1 No"WL New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is,available within 200 feet.)— Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- E + ❑ Ics'�"1No. of compartments----- Size----...-•--=--------------------Li Liquid de th_---._._--------- Capacity q P-� --- -- -------------- ------ ., 6 i Dis osal Field:: Distance from nearest well._l�..._Distance from foundation-- _- - ---- .. P �._ �_�_--.-.-Distance to nearest lot line-- . Number of lines---- -s __ � 1----Length of each line---- __ - Width of trench.-,;z, __ Type-of filter material-Pv -------Depth of filter material------ __________Total length------------------------ # --------_ .1 Seepage Pit: Distance to nearest well---------I----------Distan(fe from foundation-------------------.Distance to nearest lot line----------------- d ❑ Number of pits----------------------Lining"material: ......................Size: Diameter----------------------.Depth_----------------•--------------- r Cesspool: Distance from nearest well-`___-_-----.._Distance from foundation__---------------Lining • - material--..----____--__.-_-.-_.--_-_-_- ❑ Size: Diameteri_-- =----=-- -- ------------Depth_----- *---------------------------------------- Luid Ca acitY---------------------_--- gas. ) Privy:. Distance from nearest well-----------------__-_-------.._--------------Distance from nearest building------------------------------- ❑ Distance t'o nearest lot line ® rOT Remodeling and/or repairing (describe}:----_ -_-: -..__ �Q P d ------------------•---------------- --------- ----------------------------- - _ _ - - ----------------- ---------------•------------------------------------------------------------------------------------------ -------------------------------- I hereby certify that I/ttave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruI and regulation of the San Joaquin Local Health District. (Signed)------------------------------ ---- - - .---.------ - --------- ---------f., =`------ caner and/or Contractor] By:. =- ----------`' °_--:-----------(Title)------- f (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on re erse side). FOR DEPARTMENT USE O APPLICATION ACCEPTED BY--------------------------------------------------------- -----------L-- ---/!� ATE----- -------------- REVIEWEDBY-------------------------- --------------------------------------- ----------------------- - --------- --------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------•-------------- ------------------------------ Alterations and/or recommendations--- ------------------------------------------------------•---•--------------------------•----------•-•---------------------------•----------- = ----------------------------------------------`----------------------------------------------------- ---------------------------------------------------------------------------- ------------------------------•---------- ----------- ---------- -------------------------•---------------------------------- --------------------------------------------- --------------------------------- FINAL INSPECTION Boyeo - - - - -------------•---------------- Date- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD-