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FOR OFFICE USE: = ---- - APPLICATION FOR SANITATION PERMIT Permit No. ...I._��.�. --- r. --------------------------------- ----------- ----------- (Complete In Duplicate) Date issued _:!A • p Y This Permit Expires 1 Year From. Date Issued------------ Application is hereby made to the San Joaquin Local Healeh District for a permit to coL ct and in the work herein described. This application is ode in compliance with County Ordinance No. 549. 4_1 JOB ADDRESS A LOC ION--_. ---- -- ------- -------- --- ------ ------ ------------- ...-------•------- --- - -------------------- Address - Phon.e ---- Owner's Name----- ---- _-- ••--- - Address-------•--------- ------------ Contractor's Name---- . q � Phone- ------- f Installation will serve: Residencepartment House ❑ Commercial ❑ Traile Court ❑ Motel ❑ Other ❑ f Number of living units:f--..... er of bedrooms _..�4umber of baths ---.... Lot size .---- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.._ ft. Clay Loam Clay ❑ dobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ C Y ❑ Y VA: Yes No ❑ W Previous Application Made: (If yes,date----- ) No ❑ New Construction: Yes ❑ No FHA/ ❑ TYPEF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --------------------------------------- ptic ja :1 Distance from nearest well.................Distance from foundation--------------------Material----------Capacity........- Li ui e th------------ -- . No. of compartments- ---------- --------- Size..------------------------------ q P - � ._..Distance to nearest lot line..__ --. D' osal�iell.- Distance from Weare t welL .C��-'--.Distance from foundation. o Width of trench.-" .-. --q------ --------Number of lines._....--- .-_- Length of each line_ �� -Type of filter materia - -- -----Depth of filter material----------/ _------Total length..__.... s Seepage Pit: Distance to neares well ---------- -----Distance f m fpundation..�_Q-_.._..--D'st nce to nearest lot line---. 11 Number of pi}s-----i----_..._-----Lining material._. Size: Diameter._. - ---Depth---c2. ------------- Cesspool: Distance from nearest well..-_--..---.-.._Distance from foundation---------.-_...----Lining material--------------------------------els. ❑ Size: Diameter--------------------------------------Depth_-------------------- -----------------------------Liquid Capacity- .-------------------- ---9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------------------- ---- Remodeling and/or repairing (describe):.-----.---------- ----------------------- -- ------------------------------------ •--------------------------------------------------------------- - --- - - --- -------- ---- --`�"`�°=-'- ;T------------------------------------------ ------- ----------- - -- ------ I hereby certif that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Sta ws, a rules an gulations of +hem n�Joa Local Health District. {signed) -- .... -t l_ r ontractor} - --------(Tit e)---------------------=------ ---------- ---------------------- --------------------- (Plot plan, showing size of lot, location of system in relation t wets, buildings, #c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------- DATE------- -•-� -- -- -- ----- --------------------------------------- REVIEWED BY------------------------- ----- ---------------------- ------ --- ------------------- ------------•- ------ DATE--------------------- -------------------------------------- BUILDING PERMIT ISSUED----------- - --- ------------------ --"-"---------------•- -- DATE------------------------------------------------------------- Alterations and/or recommendation :_.__........................__....__..---.--__-- -------------------------------- ----------------- ------•------------- -•----------------- ---- FINAL INSPECTION BY-------------- ----- ------ - --------- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeilon Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rc5 9 REVI5t:4 8-59 3M 3-'63 F.P.0 C.