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FOR OFFICE USE: ---------- = �� APPLICATION FOR SANITATION PERMIT Permit / --------------------------------------------------------- __ (Complete in Duplicate) Date Issued — ---- J ------ ------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 544. �i ---- JOB ADDRESS AND LOCATION__-: ----liz.�i__-----.� ------9 -! - Owner's Name________ _ _ ;- ------ Phone Addressr 1 --------------•- --------------------' --------------------------- •---- -------- ------------- ------------------------------------------------ pop Contractor's Name--------------f� Phone ------- --------------------------- Installation will serve- Residence 'Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: __/- Number of bedrooms.___ Number of baths /__ Lot size ! f-' �--•---- Water - ---------------------- Water Supply: Public system P Community system ❑ Private [3 Depth to Water Table _ f# t Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy'Loom E] Clay Loam ❑ Clay ❑ Adobe iardpan C] ' . Previous Application Made: (if yes,dt ate---------- --) No ®—New Construction: Yes ❑ No [q-`fHA/VA: Yes ❑. No 9— TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: r Distance from nearest well-_______________Distance from foundation_.._________----_._.Material______.______.-_____--:___-______. --------- No-. ---____-.. No. ofcompartments---------- -------------Size__.------ --------------------Liquid depth------------ - -- ---------Ca Capacity.. ---------- _______________ Disposal FidDistance from nearest well-----_-_____.._Distance from foundation--------------------Distance to nearest lot line Number of lines-----------------------------------Length of each line------------------------- ---.Width of trench------ ---------------------------- Type of filter material-------------------- ---Depth of filter material--------------- ----Total length------..---------_ ----------------------- Seepage Pit: Distance to nearest well___ ---------Distani fr m foundation_"____..Distance to nearest lot lineZi Number of pi#s--.'�-----------_Lining material_ - __g9 -.-Size: Diameter_._ ------Depth_v Cesspool: Distance from nearest well-----------------Di.stance from foundation____----_-----------Lining material____.-___-..__..---_.___________-_-. ❑ Size: Diameter---' --------------------------- p -------Liquid Capacity----------------------------gals. f T . P '-_Distance from nearest building Priv Distance from nearest.well----------------------------•--------------- - 9---------------------------------------- Y ❑ Distance to neatest lot line--------- --------------------------------------------- -------------------------------------------------------- be): Elf � e € Remodeling and/or repairing (descri ---------------- i -------------------------------•-------------------------------- ------------------------------------------------------------------ - 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 rules and regulations of the San Joaquin Local Health District. I ]rte r Contract 1 (Signed)--------------------------- 1 �� - - -I��° or) �a (Title)----��1�; ' (Plot plan, showing size of lot, location of-system in rel i to wells, buildings, etc., can be' placed on reverse side). t t FOR DEPARTMENT USE ONLY WA APPLICATION ACCEPTI=D BY-._.___-IIi-------- ------------------=------ ----------- DATE-- � '� `�� - -------------------------- � REVIEWEDBY---------------------------------------------- DATE------------------------------------------- -------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------ ---- DATE--------------------------------------------- Alterations and/or recommendations--------- /_6. ----------------•-----------•-----,-: --- •----------------------------------------------------- -----------------------------�"`--'� !x- `--- ------- `= -r=------------------------- t ---------------------------------------------------------------------------------- ----------- ' FINAL INSPECTION BY:. --- f --------------- Date------- -1 ---- -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.0D.