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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 Heal+h District for a permit to construct and install the work herein described. This application is made rincompliance with County mance No. 549. �� ?��0 -- JOB ADDRESS AND LOC ION G] ----------- ---••---- Oyjwner's Name / -•----/—• ----------- Phone-----------------------------•- Address pfd Contractor's Name-----&t;�t-------------------------------------------------- ---•------------------------------------------- Phone-_------------- -------`--------- Installation ----;-------•Installation will serve: Residence �A Apartment House ❑� Commercial [3Trailer Court ❑ Motel [IOther E]-_1 Number of living units. ___.---- Number of bedrooms 1/__ Number of baths __(---_ Lot size -----f77)----- Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table _f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan A At Previous Application Made: (If yes,date--------------------) No New Construction: Yes)] o E] FHA/VA: Yes [I Nor TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No Septic tank or cesspool permitted if public sewer is available within 200 Septic Tank: Distance from nearest well_,jc?~—�.___Distance fro foundation___________-----_-MateriaL__� -- _-- _ . .__-_-__.. �s-b x - No. of compartments-------------------------Siz -------_---Liquid depth------r�_._-----------Capacity---_ -�-- --© Dis osal Field: Distance from nearest we€l.-/.}Q_._Distance from foundatio .____C5Q-.__Distance to nearest lot Iliie,1_--_.:__.-_ Number of'lines____---�-_ _ - ---Length of each line______ Q________ _____Width of trenc _ -- `-____.___._______ j- Type of filter materia19._ __Depth of filter material___ -g--_______Total length---.-_--Q0------------------------- Seepage Pit: Distance to nearest well----/67-�-------Distance from f d ti I_ p___.Distae to nearest lot line___" Number of its______/_._ --Linin material__` . Diameter_-___- 'a Depth _ P - ---- g -�"`=2� - �- ------- ---- P I-- �__---------------- Cesspool: Distance from nearest well-----------------Distance from oundation------------------- Lining material------------------------------------5 ❑ Size: Diameter------------- ------------------------Depth--•---------- Liquid Capacity galsl_ r Privy: Distance from nearest well.___________________--_________._---------.--.-Distance from anearest building-------_____________-______.___._- - "..,.. Y _..._ o Y rT_ _ _ _ �.. -- -- --------------------------------------------"----- "--:---- Distance to nearest lot line_________.._______-------------------------------------------•• r Remodeling and/or repairing {describe):------64-1-0A --- - ----- - ------•------ --- - --- -----------------------------------------------•-------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Court ordinances, State I ws, and rules and regul tions of the San Joaquin Local Health District, (Signed)-------�-� = r - ---------- ----- ----------------- ------ ---- -----------------------------------------------------jCWAA&.@#d/or Contractor)V By:------------------------------------------------- ------ --- -----------------_(Title)---- - ------------- ------ ---------- (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----:-------------------------- ----------------------- - ------------------------- DATE------------- ------------------------- REVIEWEDBY------------------------------------------ ---------•------------ ----- -- DATE- •---- > ----------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ DATE------------------------------------------------------------ Alterationsand/or recommendations--------------------------------- -- ---------------------------------------------------------•-•------------------------------------------------------------- -----------------•---------------------------------------------------- -------------- --------------------------------------------------------------------------------------------•------------------------------------------ ------------------------------ -----------------------•------------- -------- --------------------------------•------------------------------------ -------------------------------------------------------------------------- FINAL INSPECTION BY______________ __ _________ Date------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Califomia Lodi,California Manteca,Colifornia Tracy,California I ES 9 REVISED 9-59 3M 3-'63 i.P.CD.