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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ................. . ----------------- --------- _--= ------------ ----------- --- _> _ ..(Complete in Duplicate) Date Issued ---•__--- !z-� --------------------------------------------'------------ This Permit-Expires-I Year From Date lls-'L1d.6 �- 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 witCounty Ordinance No. 549.Ir _. . Phone---------- - - - --- ------------------ Owner's Name------ -------- --------------------------------------------------/ Address --------------- i '`e / lam__ � Contractor's Name.. 1 --------.-. Phone ----------------------------------- --• -------•-------------------------------------------- ---- ------- Installation will serve: Residence UVApartment House ❑ ACommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.--y--- Number of bedrooms A� Number 'of baths _cZj_ot-size ___- 1��------------------------- Water Supply: Public system [(Community system ❑ 'Private ❑ Depth to Wate' Table -//#ft. Character of sail to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;date-------------------4 -No-B--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 200 feet.) Septic Tank: Distance from nearest well--._ _____.__Distance from foundation-_.A�:.-._---Material__6�!-��"� -_ -.__-_. �( . p No.,of.compartments._•_ -- Size_ N -1/0_/'_Liquid p Capacity_ - ---------- -_-_`j; 1 _Li uld de �h___� Ca acit Disposal Field: Distance from nearest weli____'r�il_._Distance from foundation-.J- __.___Pistance to nearest lot line�.�____...{ Y Number of lines---------; _T Length of each line_&_`_x__ __.Width of trench-_-_--------------------------------- (/,--,Depth _ _ Type of.filter material_ fl _-___-Depth of filter material--.._,l -/�-__--Total _ __ ___________________ length.--- Seepage Pit: Distance to nearest well---------------- --Distance from foundation``_'_`_-.'_`*----------..Distance,to.nearest-lot line.__.-_---_----_ Number of pits------ -------`- ---Lining material--------'--------------Size:`Diameter----------------- Depth--------------.---..------------- Ces ool: Distance, from nearest well-----------------'Distance from foundation--.___- --.---.Lining material----------------- __._---------.--_. �} ❑ Size: Diameter- =A;---(Depth` � Liquid Capacity `-------------gals. 1 Privy: Distance from nearest well---.____.__'------- =------------------ ________________ -^__Distance.frohi.nearest building-_ ❑ Distance to nearest lot line. ¢ -- ------ - -------- i = >; Remodeling and/or repairing (describe)______________ _ --- - ------------------------------------------------------------- ------ - I I hereby certify that I have prepared this application and +hat the work will be done in accokdance with�Sari'Joaquin County ordinances, State laws, and rules and reg #tions of the San J quin Local Health District. f ;�• I, (Signed)_ - -- -- ----- --------- -------- -- ..(QIE=MPd&r Contractor). Il 1 Tale s- By.._.-.--••--------------------------- { ) - -------- ' [� (Plot plan, showing size of lot, location of system in r6l�ti wells,.buiIdings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED ------------------------------------- ---- DATE--/-=�_-,-F=,��------------------------------- � . REVIEWEDBY----------------------------------------- -- ------------------' ---------------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- -------------------------- ------,-------------------------------------------------------- DATE----------------------------------------F----------------- Alterations and/or recommendations:------ ._ � --•------------------------- - - ----------��- -----------777 ' 1 =fit ------------------------------ --------------------------- ------------------------------------ ----------------- -_- ----------- ----- --------------------- .--- --- ------------------------------------------------------------- - .. --------- -- ---- •------------------------ -•------- -------------- -- I FINAL INSPECTION B - - Date - --------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haallon Ave 300 West Oak Street .. 124 Sycamore Streets„ w j 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.