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�FFICE USE: = = `-- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .....: .. ------------ -------- ----- (Complete in Duplicate) y/ ---.-.... 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, --- 4�7-------- - - JOB ADDRESS AN LOC ION - J- -------*__ __�--- ---- -- -------- ----------------•-------....... • i. Owner's Name------ ----------);411,14----- ----------- ------ Phone-- or-•_-- Address - -- -- ---- ---•--••------•------------------------- Contractar's Name #- ----- _ A Phone t. - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer �t Yr Motel ❑ Other Number of living units: _ .__ Number of bedrooms �_ Number of baths --/- Lot size ...... - ._ _................_.__.___.._......- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table/,__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeVj Hardpan ❑ Previous Application Made: [If yes,date--------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes E] 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) *1�61 Distance from nearest well_________________Distance from foundation.-______.___------- Material_-----___.____._____________--_...__No. of compartments--------------------------Size-----....-----------------------Liquid depth-------------------------Capacity------------=------•--- d: Distance from nearest well-S- ----.__Distance from foundation... ................Distance to nearest lot line34Number of lines,!_-__/._..._-_.. Length of each line---_ _ __ __� Width of trench.__c?_�`........ ............----- r %fl Type.of filter.,material 5L__ _.QC --Depth of filter material-_.f_9-____,_-___Total length______________________ _ LF1 0---------- Seepage Pit: Distance to nearest we111Qd.......*---Distance om undation__,;Z0-__--______.Distance to nearest lot line____ _ .. Number of its._.- ' p 'A- Lining material �r Size: Diameter �� Depth ,r .S J Cesspool: Distance from nearest well -Distance from foundation._"' ------------Lining material------------------------------------- rn �6` ❑ Size: Diameter-- - -------------------------- Depth---------- -------------------------- - .---------Liquid Capacity----------------------------gals. �• Privy: Distance from nearest well--------------------------------------:__,______Distance from nearest building-,.------------------------------ ----- - e( f ❑ Distance to nearest. lot line---------------1----------------------=------- # ----------- e ---- - i _ } # t a +4 -------------------------------------------------- r ` Remodelin and/or rep 'ring {describe}: C - ---- ------ - - 7 e ____�_-_ __ --- _ _ ______________ ______.___.____.._.__ ____.___ --------- __ � 1 yr: ___________________________________________________________ _i___-_-..--_______�'___-_-______--______-__ _-_ __________ *'.._._._ ._.._.___.._________.______..___________._.....___.___-.. . .------------- -- .__ _.-__ __ ___________.______ t I hereby 9fe y I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, Saws, d rules nd regulations of the San Joaquin..-Local Health District. (Signed)---------- 4 t --- ------- -a------- --------- ----------------------- )Owner and/or Contractor) By•--------------------- ----------{ (Title) - p 5 (Plot plan, showing size of lot;-location!6f f.system in relation t wells, .buildings; etc' can be placed on reverse side). t �) FOR DEPARTMENT,USE ONLY �' - I APPLICATION ACCEPTED„- BY- .-j-Y . ------_ -''• - ' --------------------------------------------------- DATE_ R1ViEWED BY ------ ------------------ ---------- ------------ ---------------------------------'.DATE----- --- BUILDING PERMIT ISSUED ------------------------------=------ -- -------- - DATE-.----------------------------------- Alterations and/or recommendat' ' --- e.. t.. . ./. .. t - -- - ---------- _..__. __ --------------- ..__________ __ � -- - _ -- -------_-- ------------ ---------------------------- . ------------ ---------------------------------- -- i i a } Date--------� 7-- FINAL INSPECTION BY: C <C,4'--------------- --- -�� - -- ------------------------------------------ SAN' --- -------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CaliFornia Lodi,California Manteca,California Tracy,California E8 9 REVISED 8-59 3M 3-'63 r.F.CD.