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FOR OFFICE USE: ` r's � r Y Permit No. f APPLICATIONS FOR SANITATION PERMIT - - ---------- - - ---------------- --------------------------- ---------------------- ----------------- - "(Complete in Duplicate) Date issued _--- ----->_� --� -----•------ - Is hereby made to the San Joaquin Permit Expires 1 Year From Date Issued nd install the work herein described. t Local Health District for a permit to construct a Application y This application is made in compliance with County Ordinance No. 549* -------•------- JOBADDRESS AND LO ION__--- 0 7-------- -- --1 -- ------ ----------------------------------------------------------------------------------- JOB Name - - -------•--•-......-------------------------------------- Owner's ------------ Phone -•--- ' •--- 0 3 ---------------- ------------------------------------------------------------- Address_..--- ---- •--------- --g------------- ----------•----- Contractor's Name ••------ ` -------------------------------------------------- Phone Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ .� F 1 rooms .- -__ Number, of baths __t------Lot size.__ -- Number of living units: ---I--- Number of bed -X• 3 i � Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ._-__-- ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El -Clay Loam 11 Clay E] Adobe 51- F ardpan ❑ Previous Application Made: {If yes,daTe------------------"-) No New Construction: Yes FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS! (No septic tank or cesspool permitted if public sewer is available within 200 feet �f /O --- ------.Material-- ----- -_----- "-- I' Septic Tank: Distance from nearest weIL4_.__"__Distance from foundation_.-: __ 4 -------------Capacity____��_d" 1 No. of compartt`ments----2-----------� ,� ---.Size------ _xx q �� .Liuid (� depth f Disposal Field: Distance from nearest well.-S-0--------- from foundation__f0"_.____.___.Distance to nearest lot lin e--c�----..-- Len th of each line---7�-----------------Width of trench__ �f _4_-`- ------ Number of lines-____:_:�--" --------- : g ,� Type.of filter material' a(,A----------Depth of filter material__�_cfl_____________Total-------------------------- length----- Sd_:�------------ -� l Seepage Pit: Distance to nearest well_-LDo-f-Do Distan�e om fpundation---/.0............Distance to nearest lot line-- Seepage / `---------------- Deptn 'Ztr'------------------- Number of pits----- Lining material__ __t4z-- ----Size: Diameter_____- 3 I l Distance from nearest well_________________Distance from foundation------------------- Lining material__-_____-_--________----_______--__ Cesspool: Size: Diameter------------------ -----------------Depth------------------- --------------------------- Liquid Capacity I gals. ❑ Privy: Distance from.nearest well-----------------------------------___-----------Distance from 'nearest building-----------------------.------:------------- _- ❑ Distance to nearest lot line-----------------------------=----- --------" Y Remodeling and/or repairing (describe)=-------------------- --- --------------------------•----------•---------•-••-----------:------------------------;--•------------------ SY ------------------------------ L ------------------------------ -----------------------------------------•------------------------------------------------------------------------ ---- - - - - •- - — - - -------- ----•------ ------- •---- ---- ---- - I --------- - - Ihereby certify that I have prepared thio appli on an hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o e S Joaquin Local Health District. - ----- ----------------- ------------=----------------------(Owner and/or Contractor) l (Signed) ----- - --------------------------------------(Tifile�------------ ---- -------- --------------- - ---- --------- y-------------------------- ---------- ---------------- -- --------------- - (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 DATE----. -`Z.7------- '��----------------------- I APPLICATION ACCEPTED BY---L� "s------------------------------------------------------------------- DATE REVIEWED BY_ - - --- DATE----------------- ---- - ---------- --- --- -------- BUILDING PERMIT ISSUED - - — ------ Alterations and/or recommendations:____ _-_�s_O'--" � �s --y�1S_ K"'"-""--�A_ - -_ ------ - ----------------------------------------------------------- ----------•--------------------------- ----------------------- ------- -------- ----- P----------- 1 i ---------•---------•--------------------------- --------------- ------ ------ ------- -------- ----- FINAL INSPECTION BY:-__-.--�--.....- -�- r -------------------------- Date------( d = --------=--- ---------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-s9 3M 3•'63 F.P.C17. i