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FOR OFFICE USE: -------------=-------- --------------------------------- ---------------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit.No. � ..I q-_-- --------------------------------------------------------- (Complete in Duplicate) Date'lssued --------------------------------------------------------- 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 No. 549. ps+ct _ tqO 32 JL— f � �. •- � ,- J08 P;DDRES5 AND,LOC I .{N._X �tr_ Owner's Name = C .-� --��` Phone.---------- ------ ----•-- ------------- - -- ----------- Address x`` ---•---------------- -----------------•-}-- --------------..:---•---------•- Contractor's Name--•-- --.. -.el.. v — ----------------------- ••----------------------- Phone----------------------------------- Installation will serve: Residence Pff"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ i Other ❑ # Number of livingunits: j �_-__ Number of bedrooms _r _ Number f baths ___ Lot size - - ___________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soll to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El, Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Constructiori: Yes E] No ❑ FHA/VA: Yes ❑- No ❑ a. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_____________:_____Material----------------------------- _______------ El No. of compartments------- ---- - ----------Size--------------------------------Liquid depth ' ---------Capacity-•---- ------- Disposal Field: Distance from nearest welL______________ Distance from7foundaton___ _"='"i_____:Distance to nearest lot line:_______.__.___._ ❑ Number of lines___________________________________Length of each line------------------------------Wiclth of trench..______.____,-__�____________ --- Type of filter material_________________________Depth of filter material_ =---------------- rE _ _ -- r k ��7 f} oto length -- ---------:..- -'----�% �------- .. I. Distance to nearest well------'�-�-'-----.---Distance from foundation----•-- -----------Distance to nearest lot line----_ ".'".....'=w.'_.- ..-'C l t �'-' gyp• El Number of pits.____--------_ _"Linin ",material________._____ Size: r-____ _ s-� g � - ----- ---��_----.Depth---�p-------- ---• --------- r Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material__________________;______ j_.____. .; ize: Diameter =-------------- Depth------------------- --------_:-___ ` Liquid Capacity- ---------------- -------gals. Privy: Distance from nearest well-_______________________________________________Dista ce.from nearest building___-_.-------------------------- ❑ Distance to nearest lot line = = Remodeling and/or repairing (describe)-------- - ----- --------'----------------------------------------------------------------- -------- --------------------- ---------------------1-7------------------------------------------- ----------------------------------------------------------------------•------------------ `^`--------------••----------------•-•---------------------------------------------•---- ----------------- F j ------------------___------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------ - - -- - -------- -- ---------- •----------------------- -----.(Owner and/or Contractor) TitleBy----------- --------------------------------------( )------------- -------- ----------- .. (Plot plan, showing size of lot, location of system in rel io•n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- � I- -- - -- -- -- - --- ---------------- -------------------------------------- REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE--------------------------- BUILDING PERMIT ISSUED---------------------------- -------------- ------------- ----_-------------------------------------- DATE Alterations and/or recommendations:---------- -----------------------------------------•• -------------------------------------------•-------- ----------I---------------------------------- ------------•-------------- ----------- ------------•------------------------- ----------------------------------------------------•-----------------•------------------------- FINAL INSPECTION BY____ __ _____ ____ _ Date_�. �' !�-�,lf -----•-- - 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 EG 9 REV$SrO B•59 31A 3-'63 F.P.1213.