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FOR OFFICE USE: - -------------------------------------------------------- `/ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------:---------- - --------------------------- - (Complete in Duplicate) ------------------------------------------ --- This Permit Expires 1 Year From Date Issued 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. - -i-�� JOB ADDRESS A LOCATIONQB( ------------------ ----------- Owner's Name - Phone ----- -``- '---- - -•-•--- ------- -- -•-- --- ---- - -----�------------------ }--- •E Address.._... �-f •�'- ---•-- -•-^- . Contractor's Name----- t �� G'�=�fG - ------------- W Phone. ► Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: , Number of bedrooms -------- Number f baths _---_-_ Lot size ._--1�- --k---------_-_.__------._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table - ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam V Clay LoamClay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-- -------------_._I No � New Construction: Yes �No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septi ank: Distance from nearest well--..�Q------Distan ,e fro `ounr ptlon--.--t_0-__-_--.Material--- ___---- ' �__- ----_-. 'YY ry J' Ca acit yam, No. of compartments.-,,-- -----------------Size_. �X y Liquid depth-------- -- r P y ! f� Disposa field: Distance from nearest well--- foundation.-_-- --j---�-...Distance to nearest lo�iine-- --_ Number of lines----------/-------------- Length of each line---.- -.---.Width of trench-.. T Type of filter mater:al„�- i--- Depth of filter materia _. -------.Total length------ --- --------------------------- E �- , Seep e Pit: Distance to nearest well.--- - Distance from oundation___-�+ -_ _.__.D ta�a to nearest lof line.- ---.---.-_ Number of pits------/-----_ g Size: Diameter._--.-.._- __Depth-_":? f �. Linin material ------------------- Cesspool: Distance from nearest well-----------------Distance,from foundation-----------------.-_.Lining material------------------------------------- ' ❑ Size: €�iameter--------------------------------------Depth-- -------------------------------------------------Liquid Capacity gals. JP Privy: Y Distance from nearest well----------------------_----------_------------.Distance from nearest building---------------------___-_____.--------. ❑ Distance to nearest lot line----------------------- -------------- ----------------------------•---------------------------------------------------------------------- Remodelingand/or repairing (describe)--------------------------------------- --------------------------------------------------------------------------------------------------:----------.. -- 4 6 ----------------------------------------------------------------------------------------------------------- --•--------------------------------------------------------------------------------------------------------------- 11 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County � ordinances, Sta laws, and rules and regulations o the San :J:�o *ncalHealth District.elSi ned --- ------------- -------- weer d/or Contractor) - " ( g )-------- - ----- --�n-to --------------------------------- - Title---------- ----------- ----- ------------------- --------------_ (Title) (Plot plan—showing size-of-lot, location of system in relatiells,_.buildings, etc., can be"-placed on reverse side)' OT t # I FOR DEPARTMENT USE ONLY --------------- DATE---- - ---------------------------------------------------------------------------------- - APPLICATION ACCEPTED BY---/�" -- - - -- _: . - - - -----------f---`---y - ----------------- REVIEWEDBY"- '------- ---=-- ------�..----------------- - --------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDING ----------------------------BUILDING PERMIT ISSUED---------------------------------------------- --------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--=-- --- :_:----------------------------- -•-•-- -------------- ------------- --------------------------------------------------- -----------------------------------------------------•----:--------•-------•--------------------------------------------------- ---------- -------------------------------------------•----------------------------------------------------- ----------------------------------------•--•-------------------------------------------------------------------- --- ---------- --------- -------------I- - -------------------------------------------- ---------------------------------------------------•--------------------- -``---- -------------------------------------------- FINAL INSPECTION BY: -- - - -xv--------------------- Date--- - - ~-b ?------------- --- ------ --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 601 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California CS 9 REVISrO B-89 3M 3-'63 F.F.CC. y