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R FFICE USE: --------------------------------------------------------- APPLICATION 'FOR SANITATION PERMIT Permit No. ...,1 - ------------------------ -------------------------- -- (Complete in Duplicate) 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 install the work herein described. This application is made in compliance with County Ordinance No. 549. .- JJCCS� JOB ADDRESS AN OCATION _______ _._ _ -- -�---M_� _ 3©---- ---- Owner's Name----- -- ` = --- --------------- -- Phone-------- �_J ,Z 1 Address --.... --------- ------------- ----------------------------------------------------------------------------- ---------- -------------- --------------- ,. Contractor's Name------------------------- -•.�_ __�. �e ------------•--•--- -- - -•----- --------------...--•--•---------=------- Phone--�:6_�_�_��_47--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ '.Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms qwZ._ Number of baths .-4_ Lot size _ ----- _________________ Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay% Adobe ❑ Hardpan ❑ , Previous Application Made: (If yes,date',,__..__ -----.-)"No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ttifiak: Distance from nearest well-----------------Distance from foundation__.___________.___. Material---_-_. __-___.-______..______________:___-_____. No. of compartments---- --------------- ----Size-----------------------------•--Liquid depth__...---------------------Capacity-----------------------leid: Distance from nearest well"4--------Distance from foundation___-�/40--------Distance to nearest lot line Number of lines----- -- -- ------------------Length of each line_-- 4.`_.._-________._.Width of trench.__-rl7.1-_s__________________ Type of filter material- _C�__Depth of filter materiaL_Z-e_�_____.__Total length-----------------____� -*_____-_ ,7 _� . Seepage Pit: Distance to nearest well __�Q_�________Distanee from foundation_,74P__ ______Distance to nearest lot line----------____.._ Number of pits- --------i-.-.lining material ____Size: Diameter --R�__..___-Depth_____ �-*________.___ S Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material__._.____---______..______________._. Size: Diameter"----------------j--------------------De th_---------------------------------------------------Li uid.,Capacity----------------------------gals, Privy: Distance from nearest well...__-_________________ _-..--------- ._Distance from nesrest_building'___._______________________ ❑ Distance to nearest lot lire-="=-=-----------=......= =-----=-- ------------------------- Remodeling and/or repairing.(describe):--- s /� ------------------------------------------- ---------------------------------------------------•----------------------------------------------------._------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- --•---------------------------------------_-----------------------------•-------------------------------- --------------------------------------•------ - --------- - ----------------------------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances laws, and rules and regulations of the San Joaquin Local Health District. (Signed '- --- Owner and/or Contractor) B -- ------------------------------- - ----- Title (Piot plan, showing size of lot, location of system in relat o to wells, buildings, etc., can be placed on reverse side). $,y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.IBY-----------e_2- �----------------------- ---------------------------------------- DATE----'$-'�` 6 REVIEWEDBY--------- --------------------------------------------------------------------- --------------------------------------------- DATE----------- ------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ --------- DATE------------------------------------------------------------- Alterationsan or recommendations----------------------- - --------- --------------------"---------------------------------------•-------------------------------•------------------------- - --------"----------------C/00---------------------------•-----------------------------------------------------------------------------------------------•---------- f -----------------------------------------------------------•-------------------------- --------------------- --------------------------------------------------------------- ------------ ------------ ------------------ --------------------------------------- - --------------- ------- -------------------"-----------------•----------------------------- ---------------------------------/--------------- ----------------------- FINAL INSPECTION BY:._ .. 9..(_� Date-------------------2-G` 7 -------�- __ : SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Ffaielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California TES 9 REVISED 8-59 3M 3-'63 P.P.Cd.