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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1./__.g--_ ---------------------------------------- (Complete in Duplicate) Date Issued .fl-__,f6_7-45 -------------------------------------------- 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 Ordinance),o. 549. r JOB ADDRESS AND LOCATION--- ��- = ' )W----------------------------------------------------------------------------- r Owner's Name ------- ----- Phone-------------------------------•---- Address_.....----••-- ------------------------------------------------------------------------------------------------------------------------- I Contractor's Name'.4 - Phone------------•--•----------------- z�------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: ---Z_ Number of bedrooms __ __ Number of baths -a_- Lot size __t ______________________________ Water Supply: Public.system ❑ Community system ❑ private Llk—Depth to Water Table -.6-0 ft. Character of soil to a depth of 3 feet-' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobeardpan ❑ , Previous Application Made: (If yes,date-----------.........) No PT"' New Construction: Yes ❑ No 0` FHA/VA: Yes �r4o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Sept' Tan Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments----- -------_-----------Size-:------------------------------Liquid depth--------------------------Capacity----------------------- W Disposal Fi I Distance from nearest well..�Xl-:_--.-Distance from foundation--_fE------------Distance to nearest lot line---- _----- ❑ Number of lines--------- ----- --Length of each line-_kO--- _ --------------Width of trench Type of filter material---- G_ C____Depth of filter material'--- ---------Total length_----_` _---------------- =-- Seepage Pit- Distance to nearest well-PO .______Distance from foundation__/4P.--r-------Distance to nearest lot liner-.----- ❑ Number of pits.....I---------------Lining material _ ' C-A_-Size: Diamete .___Depth- ------------------- Cesspool: _-----__-------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------- --------- ❑ Size: Diameter----- 1------ -------- ---------------Depth --------------------------------- --------Liquid Capacity- --------------------------gals. Privy: Distance from nee est well___.-..----_-------- ------ =,__-_:_.-_._Distance from nearest building.- -_--------. _ 3 ..... ❑ Distance to nearest lot line-°- ------------------------------------------------------------------------------- ------------------------ - F Remodelingand/or repairing (describe] ------------------------ ----------------------------------------------------•-------------------------------------------------------- i i ------------------------------------------------------------------------------------------------------ ------------------------------------- ------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,-rd rules an4.;;e qu latian of the San Joaquin Local Health District. (Signed)- G ----- -- ; -----------------------------------------------(Owner and/or Contractor) A By:-----------------------------------------------I-------------------------------------------------------------------==------------(Title)------------------------Z-------- --------------- ----------- (Plot ------------------- - (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY w APPLICATION ACCEPTED BY---- ---- ----- ----------------------- DATE----- REVFEWEDBY------------------------------------------------------------------------------- ------------------------------------------ DATE----------------------------------------------------. . ... BUILDING PERMIT ISSUED---------------------- ------ - ------ DATE------------------------------ ---- ------------------------ C. Alterations and/or recommend ations:------- �.: ._ ------------------------- ` U-fr_Q---.._--------------------------- f---------------------- I ---------------------------------------- ---------------------------- ----------- -------------------------- FINAL INSPECTION BY:.____`'� __-__-!_ '` . - / Date --------- ---------------- - ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C 13.