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FOR OFFICE USE: Y3 ' APPLICATION' FOR;SANITATION PERMIT Permit No. _ .,<.-.2..7__- ---------- - --------- ------------------------- t (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 Ordlna e No. S49. I eel JOB ADDRESS AND CATION ` f,-•- --------"='----- 0 11 Owner's Name------------ -----• -------------- ----------------------- ,. Phone-------------- --------•-------- Address------------------------- I/ --Sly- - - ----- Contractor's Name------ - ---- --- �- ` Phone Installation will serve: Residence W Apartment House❑ Commercial El Trailer Court E1 Motel ❑ -Other ❑ Number of living units: __-_ Number of bedrooms _=2— Number of baths'--/ Lot size __ --,,j '. +�-------------------- Water Supply: Public:system Community system ❑ Private ❑ Depth to Water Tablet'.? ft.f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam []Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ { Previous Application Made: (If yes,date--------------------) :N o'[1 New Construction: Yes ❑ No,Wr FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4• �, { e ept ank. Distance from nearest well-----------------Distance from foundation--------------------- . ------------------------ r No. of Compartments------------- ----------rSize---- ----------------------------Liquid depth......... -----3CapacitltY p el d Distance from nearest well-----------------Distance from foundation____________________Distance to nearest lot line-________________ Number of lines----`----------.------------------Length of each 1ine------------------------------Width of Ytrench--------------- ------------------ Type,of filter material_ __r________________Depth,ofilter,material___=-;__.________,_____,Total length----.---------------------_________------ Seepage Pit: . Distance to nearest welll�t�+'�__Distance 4om f undation__ ______------- Distance to nearest.lot line --------- � Number of pi#s___='.�___-_.------Lining mater--ialA%'0 --S- Size: Diameter---3- --.-_-.-__-Depth _.. - 5,-:---------------- Cesspool: Distance from nearest well________________Distance from foundation._-_________-______Lining 'I r mate ri-al__-_-.________-_-.__-_______-- _____ Size: Diameter____-i # Depth -:_-_-----Liquid Ca acitY ______________________gals.-, Privy Distance from nearest well-----=----------- --------------------------F-_Distance from nearest building- ----------- ---------------------- ---------- '• ^� - ❑ it . Distance to nearest lot line-------------------------- --------------- ---------------------------------------- Remodeling and/or repairing (descrik e)---------------------=--- r---------- -------------------------------•--------------------------•-------------------------,.----------- ----------- - 3 . -----------------------------------------------------------------=------------------------------------------------ i I � _ = -----------p""==------------------- ---------- ------ -------- ----------------------- ---------------------------------------------------------------------------------- --------------------------•--------------y--------------.--------------- -------;-------------- --------------- I hereby ceftify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and're ulations of the San Joaquin Local Health District. ' t Owner and/or Contractor) (Signed)----- - By:. = =- ------------------------------------- -- - --------- - --- - -- ----------------( itle)--- _: (Plot plan, showing size of lot, location-of system in relation to wells, b 11 Ings, etc., can be placed on reverse side). . I r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- .--cel- - -------------- - ---------------- DATE-------- `^�s----- ------------------ REVIEWED BY------------I---- ---------------- --' -- ..a . �. .. DATES-------- BUILDINGPERMIT ISSUED---------------------------------- ------------------- -------------------------------I---------------- DATE--------_--=----------------------------------------------- Alterations and/or reconmend tions: -- - ----------------------------------- 7 - --------------------- -------- p �---------- ------------� �--------:--------- -. t----------- ------------ --------------- _ ` - --- ---------------------------------------------------- --- -- , ---------------------------------------- -- - --------------------------------------------------------------- ------------------------------------ ----------- -------------------------------------------------------- Y %�- - FINAL INSPECTION BY:.---- C `Cc-dJ 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 Manteca,California Tracy,California " ES 9 REVISED 8-59 3M 3•'63 F.F.CQ. -F