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FOR OFFICE USE: ----------------- - ------------------------ ___ APPLICATION FOR SANITATION PERMIT Permit No. ............ ------------------- -- ----------- (Complete in Duplicate) Date Issued ----�-�----- -,-- -- --------- -- ed-------------- This Permit Expires 1 Year From Date Issued . - i Application is hereby made to the San Joaquin Local Health District for a permit to co�ns�t�ru'ct'and"in-sH 11 the work herein described. This application is made in compliance w h County Ordinance No. 549. C' S " Cf/ JOB ADDRESS N LOCATIO a ------- 91----- -------------• • -------------- •--------- ------------ - Phone Owner' mg .S g d l / - i. Address-------------------- + < ` ! 7 -•-- --- t. g 09 Contractor's Name_______________________ 1 o - = � Ph ne:.- Installation will serve: Residence X Apartment House ❑ Commercial '❑ Trailer Court❑ `Motel"❑f Other[] Number of living units_ -_/--Number-of bedrooms __?_ Number of baths.-- Lot size ---------6---- -- --- ---- •-------------- A., Water Supply: Public syste ❑ Community,system IT❑ Private Depth to Water Table'�r ft. wX ' Character of soil to a depth o f 3 feet:. .Sand.❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ �, . Previous Application Made: if yes,date---- " No ❑ New Construction-. Yes ❑ No FHA/VA: Yes E] No ❑ f TYPE OF INSTALLATION _AND SPECIFICATIONS: _- _ r . . .._ (Na septic+ank4or cesspool if public sewer is available within 204 feet) y r pt ank: Distance from nearest'w_ei1____ ---------I-Distance from foundation-------------!_ Material--------------------------------------------------t No. of compartments."*"ir--------------- -Size----------------- i Liq ©eP.th Capacity;--------------------- d Dis osal field: Distance from nearest weil_6 ._�_ Distance from foundation _______,--_.:_Distance to nearest lot iine----`5---_-.�`.. ' Number of lines_-_-____-J�----------_--��-Length of each ----- line -sy__..._.Width of trench.____.. _ ---------- ------- _.___.___ '€ Type of filter,material._; *6e Depth.of filter material-__f-a- -_____.___Total length___________________ -_.---__.___- f r # S i Seepa a Pit: Distance to nearest iwell_!-CQ___._-`t`--Distance.�om foundation___t74__------Dista�e to nearest lot line-_----4___.__-._ Number of pits-_-----/------------Lining material'. ----Size:;D•:ameter-_3__3-------------Depth-------JIR_4�_____________:G Cesspool: Distance from .nearest well -from;from founda�t an.__ _ -__'_____.Lining material___- _____-__._.____ __. ' Size: Diameter:---------------------------- --------De th-------- --- Liquid Capacity gals. ❑ - Di.�tance .from nea.rest.buildin Privy: Distance from nearest well______________________________._____--___.__.._ [] Distance to nearest lot line -------------------------- - :. -- ------ - r i w✓ 4 Remodeling and/or repairing (describe)---------------------- - _...__ - --------------T T f l-----------------------------"--------------- -------------------------------------------------------------------------------------------s-------------------------------- t --------••------------- -----•----I------------------------------------------------------------- e % Ii --------------------------------------'--------- -------•---•-•-------------------------------------•-------I--•---------------- ----------- ------= ------------------------------------------------------ --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, c1nd rules and regulations of the San Joaquin Local Health District. ) 'I [Signed} -�- _ _ : - - =' -_[. wner .nd/or Contractor) -- tle)n- . - p ----------- Plot Ian, showing size of lot, location of system in relation to wells, buildi etc., can be laced s `2d [ p on reverse side}. a _ FOR DEPARTMENT USE ONLY 5^ il. APPLICATION ACCEPTED BY.._ � �-�.�-- ------------------------------------�-------------'-------- DATE � �� - �- REVIEWEDBY-------------------------------- --------------- --• 4---------`----`---- ------------------- - bAT�2!t_' ___ -------•h 3 BUILDING PERMIT ISSUED--------- -- ------------------------------------------------ r- ------=- ----------•------------------ b_AT;E---�-------- --------�- = - ---- ---------- l� r r Alterations and/or recommendations:----- ------------- - ' -- -- --------- - ----- ----••------------------------------ --•-•-- t { -- - -----------------------------------__ __________________________________________________________________________________________________________________Y____... _...._. ------------ I -t -----'r' 3 I f---------t ----- -------------- r �..,.,.. .,, w o.... .� t FINAL INSPECTION BY� _ �� .�� f Date = SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rS 9 REVISED B-59 3M 3-'63 F.P.CD. �-