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FFOR OFFICE USE. -------------------=------------------------------------- � -------------------------------- --- ---------- --------- APPLICATION FOR SANITATION PERMIT Permit ------------------ -------------------------------------- (Complete in Duplicate) ,J --------------- -------------- -------------- � This Permit Expires 1 Year From Date Issued 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. ��_ 0Yo-01 JOB ADDRESS AND LOCATION.-4t -------------- - Q, Owner's Name 4 - Phone-_. --------------------------------- --------------- Address--------------- .. / r , Contractor's Name------------------ -------- ---XV -." --------- Phone.---..--. ---•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/--- Number of bedroom_ Number 'baths --- Lot size --- ------------------------Wafei• Supply: Public system ❑ Community system ❑ -Private Depth t ater Table -------- ft, f F Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam Cray Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 4 Previous Application Made: (if yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑_ — TYPE OF INSTALLATION AND SPECIFICATIONS: �. c (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic ank: Distance from nearest well _+ -------Distance from�x�)nd,fipn_:_--� ---.__.Mat ilei------ - .. -_.-- -No. of compartments--------- _Sizex -------. - - - �2GG . _ x`a� Liquid depth Capacity-/ f = % ? Dispo Field: Distance from nearest well.-- ---__Distance from foundation-- _ _ Y, !� ---_.Distance to nearest I t line- ------------ Number of lines-:-__--,�-----__ Lengf..h of each line------ ------ -- Width of trench_ Q y-----------_: Type of filter material - i-_ a------Depth of,filter material_-_--� --- Total length--_.----- -s -----___ ------------- Seepage Pit: . Distance to nearest well----------------------Distance from foundation_-______.-----------Distance to nearest lot line---___------_--- G ❑ Number of pits.--`------------------Lining material---------- -------Size: Diameter-- ----- ----------- Dept --------------------------------- Cesspool: ' Y r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linin g material.-:--_"' -------------- N t t El Size: Diameter------------------------- - Depth -Liquid Capacity-------------------------...gals., w Privy: Distance from nearest well------------------- -----------------------------Disfance from nearest.-buildin F ----------- ❑ Distance to nearest lot line------_.__------ Remodeling and/or repairing (describe)----- -- ----------- --------------------- --- .9 � ------------------------------- ------------------------------------------------------------- I t ----------------- -------fp I hereby certify that I have prepared this application and ihal the work will be done In accordance with San Joaquin County ordinances, State law , nd rules and regulations of the San Joaquin Local Health District. . --P (Signed.)---------------- -- i ---------------- ---- :----------- ---- - _._ and/or Con- cforl. By=------------ ------ 1---- -----(Title)---------------------------------- --- -- -----------= . (Plot plan, showing size of lot, location of sy em in rela 'on to wells, buildings, etc., can be placed on reverse side]. , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- ------- ------------- ------ ,} --- ------------------------------------------------ DATE -� - - --- I---------------------------,- I REVIEWED E I - ----- - -------- ---------------------------- -------------------------- DATE----------------------------- UILDING PERMIT ISSUED ------ DA•TE--------------•----- ' ---------------------------------------------------- Aterations and/or recommendations----------------------- ---- -------- r -----------•-•------------------------------ --------•---------- --------- -- ----------•-------•----- -------------- ---- •------- - ---------•----------------------------- ----------------------------------II --------------------------------- --------------------- ------------------------------- FINAL INSPECTION BY:.--- s1 ----- , ------------ Date---'�'-^�-� -�"'-------- ------------= S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street-, r Stockton,California Lodi,California 'Manteca, California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.P.00. -