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r FOR OFFICE USE: — �42 ----- ------------------ ------------------ Permit No. /2. 7/..... --------------- ------- ----------------- -------- �- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) _,.4 ------- ---------- ------ --.�:--- ----_.--. � Date Issued ----------------------------------------------- This Permit Expires 1 Year From Date Issued 2-0�, , ZeO— 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. € JOB ADDRESS AI�fD_ OCATIO v _ �r�L r- ------ JOB Nam ------------------------ --------- --- - ----------- ..--- ----- Phone - ------- - Address----- ------- - ---�/------=-- - r ----------•---------•--- ------ - ------ ------- -- -- _ _-•_ -------- --- Phone----------------------------------- Contractor's Name----------------------•- ------ ------- ]� Installation will serve: Residence �J Apartment House ❑Iommercial ❑ Trailer Court ❑ Mo 1 ❑ Other ❑ Number of living units:_-- Number of berooms ___-____ Number of baths ________ Lot size _________________ ------------------------ d Water Supply: Public system ElCommunity system E] Private Depth to Water Table S _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy L am ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) N New Construction: Yes No FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Ta k: t�lce from nearest well_________________Distance from foundation__._______--._.__.-Material_________._.__._______._------_---_--=-------- No 6f compartments------ ------------------Size-----•-------------------------Liquid depth---------------- --------,Capacity--------- Dis o I Field: Di ,ante from nearest w 11_I.Offl_�'Distance from found t' n /4?P�-Distance to nearest lot lie�__ fNumber of lines------------- -------------------Length of each line__ �.� ---_<-.-----Width of trench. -1 -------------- ----------- c �t Type of filter material__} epth of filter material----�_ ___-_____Total length-,-.----- ------------ Seepage Pit: Distance to nearest well__--------------------Disfiance from foundation____.___.___-- _:Distance to nearest lot line------------------ Seepage Number of pits----------------------Lining material--------- -------- Size: Diameter-----------------------Dept h_.------------------------------- rr Cesspool: Distance from nearest well-----------------Distance from foundation._.._- -_.--_._..Lining material_--__._______.___.__.__--__________- C ❑ Size: Diameter--------------------------------------Depth ---- ---- ---------------------Liquid Capacity----------------------------gals. c '_.__,.._ ,_.__'s --- Privyr `- Distance-from nearest'well----------------------------------------------- _._Distance;from nearest building__-- ._.____. ❑ Distance to nearest lot line. ---------------= =- ; Rem r i nd/or_re,p-airin scribe}:---_ -- 11 = t ----'>��- --�-�•----ltd -� - --�-�-;:ter---��-� -�-�<i�----- ---- i - -------- --- c 3, :c !R_c - Cwill be done in accordance with San Joaquin C -- -- ---- County I hereby certify that I have prepared this applica 'on and that the w ° ordinances, State laws, and rules and regulations of the San Joaquin Lq al Health District. . P, --'--------------------------------- {Owner and/or Contractor] Sined - -- ------------ ------- By:---------------- -------------------------------- ---- ----------------•------------------------------ -----(Title)-------------------------------- ------------ -------- --------- (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 APPLICATIONACCEPTED BY--------------------- --------------- ------------------------ ---- -- --------- DATE.-------------------------------------------------------- -- DATE----- REVIEWEDBY--------------------------------------------------------------- � - ---- �- ------------- BUILDING PERMIT ISSUED= ---------------- DATE I r Alterations and/or recommendations--------------- ------ •-------------•------- -------------------------------------- --------------------------------------------------------------- --- FINAL INSPECTION BY:----------- Date------------- � -�- (--�-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 bot E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r r . CS 9 REVISED 8-59 3M 3-'63 F.RCG- y