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APPLICATION FOR SANITATION PERMIT Permit No. ../71 ---------------- - ---------------------- --------------- (Complete in Duplicate) Date Issued . I - ________._' 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. JOB ADDRESS AND LOCATION__ -1-------------------------- ----------- - ----•-. ---- ------ ---------------•---------=----------------•---------------- ---------- Owner's Name__-- - - - r� ------ ------------- ---------------------------- ---- Phone r Address-----•-----•----=--'---- ---------------- --,-�C�'� 1. -- �---------------•--••-------•-----•-----------------•-----�� ------- Contractor's Name_ one ._. .._!_. /4/2— a Ph Installation will serve: `Residence [R�partment House ElCommercial [ITrailer Court [IMotel ❑ Other [I Number of living units: __-__ Number of bedrooms _ -_ Number of baths _ -- Lot size .-___-__-_��j�---- `' L Water. Supply: Public system�[�Community system El1 Private ❑ Depth to Water Table/ _ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel Q Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dbte--------------------) No ❑ New n onstruction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Sep#'sc Tank: Distance from nearest.well!! ! '--Distanye from foundation_, _______- Mate�ial___ _____________ _________________::______"fns Q i No. of comparjments----_ _-_ y 1 - Size �sJ�-�- -�--•Liquid depth ' Capacity_I s , -� ------------ Disposal Disposal Field: Distance from'hearestrwell --Distance from foundation--�------------Di rice to nearest lot line_ __________ Number of dines_- __ -- 1_ ~-Length of each lines-�" f�.—�-'`Mth of trench_._.__ __ .i..___ --'---- E p ! Type of filter m'aterial�7` --Depth of filter material___-f_ ______Total length_______„ a.l ____________________ _ Seepage Pit: Distance to nearest well--_____,,__,,im__:-Distance from foundation-------------____-.Distance to nearest lot line----.-._____.____ ❑ Number of pits- --- -----------Lining material------------ --- ----.Size: Diameter-,---------------------Depth--------------------------------- i 4 Cesspool: Distance from nearest well-________________Distance from foundation...-_._.___--__,_..Lining•material-_._______--_-_---___._____--_____. �. _... T Liquid Capacity------------- gax ❑ Size: Diameter--------------------------------------Depth------------------ = s }D.istance from nearest building i Privy: Distance-from nearest well.---------------- ---- ----------------� ,. 9 a }----------------- ----- Distance to nearest lot line---------------------- •----------=---------------------------•- Remodeling and/or repairing (describe):----- -- -------- -----------------••-------------------------- •---------------------------- ,fl i --••---------- -----------------------------------------------------------------•---------------------------- 3 --------------------------•------------------------•--------------------------------- - ='--------------------•-------•-----------------•----•---------•-•----••-•--- ---------•-----------------•----------------------------------•---------------------------------------- ------------------------------ --------------------- 1 hereby certify that I have prepared this application rand that the work will be done in accordance with San Joaquin County ordinances, a 41aws, d rules and gula#ions of the n Joaquin Local Health District.(Signed)--------•- -- ....... ----- ---------------------------. r an Contractor) _( wne or c o `, *I r - -------------- -- --- - ------ �-----41: {Title) (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed o reverse side}. # FOR DEPARTMENT USE ONLY 14 APPLICATION ACCEPTED BY - ------ DATE---q -----¢Zf--------- C 1 4 REVIEWEDBY---------------------- =----------- --------------------------------------. DATE--------------------------------------------- ------------- BUILDINGPERMIT ISSUED----------------------------- ---- -------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------- ---------- -------------- -- ------------------------------------------- ---•-------•-•-------- ------•--------- =------------ ------ ------- --------------i--------------------------------------------------------• ------•---------------•--------------------•----=--------- -- ..+ t t -----------------•---------------------------------------------- ------ s- ��..' w... . . -. ------ s Date �f- --------------------- i FINAL INSPECTION BY:.,�.i--- Y � --------- SAN JOAQUIN LOCAL HEALTH DISTRICT t' 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California r FS 9 REVISED 8-59 3M 3-'63 F.P.r U. i - -