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FOR�)FFICE USE: ---------- ------------------------ APPLICATION FOR SANITATION PERMIT g Permit No. .. --------------------------- -- -------------------------- (Complete in Duplicate) /Of 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 in all the work herein clescribed. This applicatiori is made in compliant with County Ordinance No. 549. [ k j•- (ro t Z F (� �� -�e'r' JOB ADDRESS AND �� CAT10N �---- -��------ ----------- ------- �- ---mac -�/��-- -.. -- -=��------`�--- �' Owner's Name------(: __ l�_.-_._.. ------------------------------------ --------- Phone------------------------------------- Address -----------•--1._-••--'--_Address ) = -----------------------------------------------------------=---------- Contractor's Name----------------- -------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ..____ Number of bedrooms __ Number of baths _-f--__ Lot size . kJ__ � _______________: Water Supply: Public system ❑ Community system ❑ P'rivate 0 Depth to Waterf•Table Character of soil to a depth of 3 feet: Sand ❑l Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑' Previous Application Made: (If yes,date----------- ---_---,k , No [3I New Construction: Ye`s-'❑,"NoK FHA/VA:;Yes ❑ No ❑' TYPE OF INSTALLATION AND SPECIFICATIONS- # �~ (No septic tank or cesspool permitted if public sewer is available within 204 feet,)� •( +«W -�-+ ' 1 1:_ Tank: Distance from nearest well........_$------Distance from foundation--------------------Material_--_-_._____._.._______________-._____._____: No. of.compartments--------------------------Size-------------------------------Liquid depth-------------- -------- Capacity------------ Disposa Field: Distance from nearest well.il _.__-._-Distance from foundation_>��___------Distance to nearest lot line. pt�_f Number of lines-------- / Lengthiof each' line-----s _`__��__.._.Width of trench_.__ _ -!'---------------- ------------ � ------- _ f`07 Type of filter material ,` �' ,Depth of filter material____- ------Total length-------_____________-5. ......... Seepage Pit: Distance to nearest welljD_L1...__....Distance from f ndation �C3QDistance to nearest lot line__aQ t " Number of its______ ./. a r --------------- Cesspool: l p -/-------___--Lining material=�� -_-Size: Diameter_�1�"�---��-------:Deptn----�.�----------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material------_----------------- -------- ___� -` ❑ Size: Diameter-------------------------------------Depth-A-------------------------- ----------------------Liquid Capacity---------------------- ----gaflc� ' Privy: Distance from,nea•rest:well----------- -------------------------------Distance from nearest building------------------------------------- 13..., , ❑ Distance to nearest lot line_____________________ �4 ¢ ---------------------------•-----------------•-•---------------------------------------------- '-- `� Remodeling and/or repairing (describe)____________________ -"'- Q # -----------------••----•-------------•--------------------------••---------•--- 1 t l - , y g---•------------------------•--------------------------------------- --_-.: I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County L,. +' ordinances, Sta Iaws, and rules and regulations of the San Joaquin Local Health District. _ f '� _ l r - (Signed) n ------------------ ----------------- ------------ ----(Owner and/or,Contractor) d ---------------------- -- —- ------- - - - ------------------------------------------(Title)------�------- ------------ By: (Plot plan, showing size of lot, location of system in r tion to.wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- __-- -� DATE_ REVIEWEDBY------------------:---------------------- -------------------------------------------------- --------------------------------- DATE-------------------•------------- ILDINGPERMIT ISSUED------------•---•--------------------------------------------- -------------------------- --------- DATE--------------------•-f Alterations and/or recommendati ns:__�5�._-." - _j_---4t- -------_2 --_tom es -- 1'r2�, -- -------- -------------•---•--- U ..-- ----- - 1 . a/ "E 1------- w Q-I&....--WtA ---- ---- `18 -------�r>< ---------- ----�-- - ----- -- -- - -------- .----------- ----------------------------- ----- - ---- ------------ -- FINAL INSPECTION BY:.----Q-� ------------------------------- Date----.Lf�-�_ - ^� SAN JOAQUIN LOCAL HEALTH DISTRICT + 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.F,CD.