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FOR OFFICE USE: S& -------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....�.7 . ...Z ----------------------- - --- -------------------------- ryry ------------------------------------- ------- --- -- (Complete in Duplicate) - 71�--a,6/ _.__._._ '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 compliane with County Ordinance No. 549.-' L 0 b I X f. JOB ADDRESS AND LOCATION-/- ,r -- l c =-------- - Owne'r's Name- - ----- - . Phone-------------------------------------- o Address------- Contractor's Name------------ ---- ------ --- -=-.. --- Phone-------•--------- -- Installation will serve: Residence ❑ Apartment House ❑ : Commercial E] Trailer Court ElMotel ElOther F]174/ J'4/ J' ' Number of living units: -------- Number of bedrooms Number of baths ________ Lot size ------ ----------------------------------------- Wates Supply: Public system E] Community system [-] ,Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [?r/Hardpan ❑ Previous Application Made: (If yes,date.........:..........I No ❑ New Constr;uctio n: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; -Ay, 5 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' '* Septic Tank: Distance from nearest well-------------------Distance from foundation._-___�^____Material________________________________________________ No. of compartments"-_-___.____-x _ Disposal Field: Distance from nearest well,_f f Size________________""__"____"._--__quid depth_ __________________Capacity___-_________________ ❑ _.__- Distance from foundation--------------------Distance to nearest lot line,----------------- ❑ Number of lines-----------------------------------Length of each line-_'2-----------------------Widthof.trench-------------,--.._.------_---- _Type of filter material-------------------------Depth of-filter material----------------,___---Total length------------------ Seepa Pit: Distance to nearest we'll______ ----------Distance fro oundation----e _ .___.Distance to nearest lot line-- 5---/ 1 i Number of pits__.._.----------Lining material--e. ._-__-Size: Diameter.___�_4__��_------Depth_._��__---------------- 4-- Cesspool: Distance fromearest well-----------------Distance from foundation---_-----------------Lining material---____ ---------- El 4 Size: Diamefer-------------------------------------De th--------------- ----__ ------.Liquid Capacity :.---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_________:___.________________________._.� EiDistance to'nearest lot line--------- ------------------------------=----- ------------------------ --------------------------------- -------- --- L► 11 Remodeling and/or repairing}(describe}=--------- o - I ----------------------------------------------------------------- ----------- -- ------- - , ------------------------------- ------------------------------------------- ------ -------- ----------------------------------------------------------------------------=----•----------------------------------- - --- -- -- I hereby certify that I.have prepared this application and that the.work will be done in accordance with San Joaquin CountyI ordinances, State lawy' nd rules and regulations of the San Joaquin Local Health District. Si ned ------------------ ---- " -' +f � nd or Contractor { 9 } - -------------- ---- _ ) ------ ----------- -------- ------- y--------- - --- - ------- ---- --- -- {Title) -------------- ' ................. -------------- (Plot plan, showing size of lot, location of system in re ation to wells, b Idings, etc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY APPLICATION.ACCEPTED BY---- - ------------------------------------------------------- DATE---------------- ------ ---- ------- ----------------- REVIEWEDSY- '' ---------•-------------------- ---------------------------------------------- 7-------------------------------- DATE-----1------- BUILDINGPERMIT ISSUED------------------- ------------------------------------------------------------------ DATE.----- ---------� ----- Alterations and/or recommendations:.:--------------------------- ------------------ ----------------------------------- -----------•------------=-- f ; - ------ -------- ------ -----------------------------------------•----------- --------------------------------------------------------- -- ---------------- - - . ------------ ----- ---------------- ------ ----- r I - i FINAL-INSPECTION,BY:__ . .. __ M Date- ------------------------------------------------------- SAN -----------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1 x 1601 E.Haxel+on Ave. 300 West Oak Street 124 Sycamore Street, t f 205 West 9th Street r Stockton,California Lodi,California Man+oma ca CaliforniaTracy,California ES 9 REVISED 9-59 3M 3•'63 F.P.CC. f