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- OR OFFICE USE: . ` ---_-- I'PLICATIbhVFOR SANITATION PERMIT Permit No �--- ---- i --- - '. - -;Complete in Duplicated -- ---- ----- ------ ------------- ----------- - Date Issued --- _.__. This-, 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 Ordinanc No. 549. JOB ADDRESS A OCATION-- -(�- ...f � t Owner's Name „1� i--_� C-7-71. Phone------------------------------------ ------------------- Address------------------------------------ •- • ------ ---- . _....-------------------•------••-------------......------------------ � Contractor's Name. - - --•---------- ---- Phone Installation will serve: Residence ❑ Apartment House ❑! Commercial ❑ Trailer Court Motel C] Other E]� r t Number of living units: __-- Number of bedrooms -1------ Number of baths -------- Lot size ...... Q- LQ------------------- Water Supply: Public system ❑ Community system ❑ Private [( Depth to Water Table 41A ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ E , Previous Application Made: {If yes,date-------------------- No E] New Construction: Yes El No>r FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND 'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T t' ank: Distance from nearest well-________________Distance from foundation--------------------Material------------------ __________----_,--_-____.No. of compartments------------ - ----------Size---------------------------------Liquid depth------------------------._Capacity----------------------- }, o iew: Distance from nearest well-----------.-----Distance from foundation..------------------Distance to nearest lot line _..__.__.__ Number of lines-----------------------------------Length of each line-.-----------------------------Width of french.------------..------------------- Type of filter.material-------------------------Depth of filter material------------------- ---Total length--------------------•---------/------------- Seepace Pit: Distance to nUj earest well Q__�._.___Distan om f undation_-�Q..�__.Distance to nearest lot line!__�.�_._ ,x ri t Number of pits'_ __._____--Lining material �_..5ize: Diameter____,._------Dept h...._p -,S----_._________ 4 Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material_...____.__________.___-__._________ ❑ Size: Diameter---------------------------- ------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from'lnearest well-------------------------------------------------Distance from nearest building----------------------------------------- y ❑ Distance to nearest lot line------------------- _ __ -- Remodeling and/or repairing (describe -------- ----------- - --- - -- - ----------------.------ ----------•--- -- --------------------------------------------------------- --- ----- --------- ----------------------------------------------------- - -- •------------------------------------------ I--------------------° -------------------•---------••----------------------------- --------------------- ------- --------------------------- 4 ;1 I hereb c tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tat Laws; and les and r lations of the San Joaquin Local Health District. - Owner and/or Contractor] (Signed)-------- - • ----------- -- - ---�--=----. ---- - ------------- -- - ---------------- (Title)-- By:-- ---- ------ - (Plot plan, showing size of lot, location of.system in relation to wells,.buildings tc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY # t DATE Z q' s APPLICATION ACCEPTED 13Y..1-C ---------=-- ------- --------------------------------------- REVIEWEDBY-------------------------------------------- ---------------------------------------- --------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------_�4--------------------------------------- ----- -------------------------- DATE-- ---------- ---------------- ---------------- ------------ Alterations and/orrecommendations:_Uj_-?-.$_~�------- -1-S* i v`- � --------fit=- s'� `S`---------- JJ - �°-... S---- ------------------------------------------------------------------------------------------- ---------------------- ----------------------------------------- ----- ----------------------- --------------------------------------------------------------- - i FINAL INSPECTION ----------=--------------- ------- - Date----�° �--------- ---- ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasalton Ave. i 300 West Oak Street 124 Sycamore Street 205 West 9th Street c a. Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CC.