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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 n,tall e worterei described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS ANr-IXOCATION,[- _ --------------------------------------------------.- Owner's Name--- ---------------------------- Phone-----•---••-------------------••---- /f u Address ------ -, -------- -- -- ------- - Contractor's Name- `/------- -------- .-.-------------- Phone.............------------------ Installation will serve: Residence [Z[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other a fE Number of living units: __.- - Number of bedrooms --- --: Number of/baths -_ --_ Lot size -------------- ------------- -4__ .�-______ 1 ------------ Water Supply: Public system ❑ Community system ❑ Private eDepth to Water Table _Z-- ft. Character of soil to a depth of 3 feet: Sand ❑ ,Gravel ❑ Sandy Loam ❑ Clay Loam ,Clay E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------=---------) No 01 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.) f Septic ank: Distance from nearest well___------Distance from foundation----/47-- Materiai--- k No-of compartments ��_;',�---..__Size=�� (� iquid depth-- Capacity � ��'1 -Q Disp sal Distance from nearest well---..�'�--_..Distance from foundation-----� -� �-___-.-.Distance to nearest lot line---_ -�. o Field: Number of lines---------- --------_____. Length of each line- C?--- -.---- E q----.Width of trench--------�----'- - -------------- Type of filter material:____-Depth of filter material---------/4?` 'f--Total length ._-..O � 9 ------------------- Seepage Pit: Distance to nearest well-------------- _-_Distance from foundation--------------------Distance to nearest lot line __.-------.•-_-_� p -Lining material-----------------------Size: Diameter----------------------Depth---------------------•---------- ❑ Number of its--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- Z ❑ Size: Diameter. -----------Depth ----------Liquid Capacity-- -------------------- gals. r. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------_------- ------ �❑ Distance to nearest lot line ------------------------------------------------ a Remodeling and/or repairing (describe)----------------------.-------------------------------------------- --------------------------------- ----------------------------- F --------------------------------------- -----_�_.---[_ -_._-.-- _-.._________________ ---------------------------------------------------------------------------.-----------------------.- ---------------------------------------------------------------------.--_-_---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru"l/es/and regulations of the San Joaquin Local Health District. (Signed}--------------------- I---'1 ` --�------ 2 ------ ------- F �•-!L -(Owner ab Contractor) or _ (Plot plan, showing size of,lot, location of system in relation.to wellsfbngs, etc., canP e) uildit (be )laced on reverse side). �FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY E'-;r-i--- DATE---- f----- REVIEWEDBY-------- ---------i-------------------------- ----------------------------------_------------------------------------------- DATE BUILDING PERMIT ISSLIED---------------------------------- ------ DATE- -------------------------- -- -- ---------------------- Alterations and/or recommendations------------------------------------------------ --------------- '--------•--q------------------------------------------------'---`--------------------------`------------------------------------------- -------------------------------------------------------_--------------------------------------------------1 1 ------------------------------------------------------------------- FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.F.CD.