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F?R OFFICE USE: . / _----.---____--------------__._- APPLICATION FOR SANITATION PERMIT Permit No. ._ ..... (Complete in Duplicate) Date Issued _____ This Permit 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 h rein described. This application is made in compliance with County Ordine ce No. 549. _._ JOB ADDRESS AN OC TIOPI'" t ` F-- = ----- ,/ Owner's Name-------- --- ---------•-_... . ••-------- .•. ••--- ........ -- Phone./ Address---------------------- = .l-_ - -- -•-s-- ... /, - ` .. �U� r---------------------_--- Phone_ Contractor's Nama7_ _T_A �Y-...._ Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... Number of bedrooms _. ___- Number of baths _ ._ Lot size `f Q / - ----- ----- ---------- -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table G.�. ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8-'-H'ardpan ❑ Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes ❑ No ET-_'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu ' sewer is available within 200 feet.) /� Septic Tank:_ Distance from nearest II_ ---Dista Dista �e from foun�tion___/Q__f_--.Materi 1 --.'----------------------------•-_-._.---.. . No. of compartments_._.___.---_-___.Siz _ �.,___:___Liquid depth___ ` .._____._Capacity.._._Ir > Disp al Field: Distance from nearest well-'rQ_---- ._Distance from foundationI.P.- __ �_Distance to nearest lot linne__�....... Number of lines___`�____,,_�___�_____�_ _]r Length of each line--- _. --_-.Width of trench.._/__�-------------_._ ` , Type of filter materia ? !�141(__Depth of filter material___..___•� ��__.Total length_______________ _r___._------ N ' )) 100, Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- '-W ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth--------------------------------- V) Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.__----_.-_-_________-____-_-_-. ❑ Size: Diameter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity---_----------------------- �+J Privy: Distance from nearest well-----------------------------------------------..Distance from nearest building__-___________-___-.-.-•--------_-___---_. ❑ Distance to nearest lot line----------------------------------------•--------------•-•-•------------------•----------------------•---------------------------.... Remodeling and/or repairing (describe) " -=--------- Vl --------------------------------------------------------------- ---- �-e � - -... = - -- �— ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cour ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)___`))�---baj. "kk__9414)---f 0-1j,=--- - tt E? --------------1�"- r Contrac' By:-------------------------------------------------------------------------------------- - ----•----•- .......(Title)------------------------------------------------------ (Plot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. t d ------------------------------------ DATE•-----. -1 REVIEWEDBY------------------------------------------------------------------ ------------------- -------------------------------------- DATE-------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------------- Alterations and/or 1r-,-e170-c--!---m--men--d----a----f--i--o--n--s------------------------.--.-..-- -___._'._.___ __ -------_. --- -- 'tic °n �4 kj--- ----- --- ----- iuL �' �-t - -- ----teA l - ----- ly FINAL INSPECTIBY:-------- e. ----------------- Date ON td ------/,n. =V-=----�----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CC.