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FOR OFFICE USE: , - - - ------------------- i7f�3 ----- - ------------- .---------------- -------------------------- 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 herein described. This application is made in compliance�,with County Ordinance No. 549. f �3-l�[fiJ -dam JOB ADDRESS AND LOCATION ---------------- ------ " -- --- . , l h-6ne --------------------------------- Owner's Name y� ••-------F�-�-c-�-T-----7-------------------�---- --: �a --` � ` � r�-1_` '.tAddress-- --------- ---------------------- Contractor's "X- Contractors Name--------�--- �`� -�- � = y � hone-------------------- Installation ... .._ Installation : ' . will serve: Residence ❑ Apartment House ❑ CommercialTrailer Court ❑ Motel 0 Other i Number of living units: -------- Number of bedrooms ________ Number of baths -�____ Lot size _ _.__ __, ---- Water Supply: Public,system P-158mmunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej—"qardpan ❑ �. Previous Application Made: (If yes,date--------------------) No 0'�'New Construction: Yes Ej--No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic T nk: Distance from nearest wet#___ i-Distance from foundaEon___1'-�______Material-_ _ -------------- J �C -- No_ of compartments----------� -------Siize--_ - � J Liquid depth---------- -.-.--Capaci ------------ -/-- Dis osaI Feld: Distance from nearest well-l�-C-- Nance from foul///dation___4_�...__-Distance to nearest lot line_ p3 _"------ ----------Length of each line-r � � -Width of trench-.--- __ --__-____._._ ? Number of lines___:________ Type of filter materiaL__ �� {��Depth of filter material____-, ____-___Total length______: _ _ Seepage Pit: Distance to nearest well----------------_-----Distance from foundation--------------------Distance to nearest lot line_____.--_--.-._-- ❑ Number of pits----------------------Lining material----------------------Size: Diameter-----------------------Depth--------------------------------- C Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- tAa ❑ Size: Diameter----`-------------------------------Depth------------------------------------------- --------Liquid Capacity--------------------------gals. 1 Privy: f� -Distance,from-nearest well_- _- _' __.___:__:_-_____Distance from nearest buildin -_-g-=-----------i-I---------------------- ❑ I Distance to nearest lot line---------------------------------------------------`-----_-------------•-�------•-- I __--'---- fes„L-. --� ----------------- -------------------------------- :� Remodelin and/or repairing {descriUe):_-;_-- ��----"-- - - ------------------ ---------- I � ----------------------------------------------- ---------------- t hereby certify that I have prepared this application and that the work will be done in accor'dance'with San'Joaquin County l ordinances, State aw and,(ules ands . .gulations;of fhe•Sa oaquin Local Health District. J ""• ^'(� (Signed)- ------------ C - - f------ ---1 /bv-t-AAJ _(Owner and/or Contractor) } BY------- '= --- ----•- - �- Com`-------= ----- -- -----(Title)---- - � i .fl'► l l -------------------------- (Plot plan, s ing size of1otl4ocation of system-in relation.,to•wells,-buildings, etc:,-can be placed on•reverse--side). t FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY--- C,x2�-1=" - DATE------`— -•�-f REVIEWEDBY = _ -------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------ ----- ------------------- DATE:y----=--- `- Alterations and/or recommendations------------_________--------------------------- € «� s ------•---------------------------------------------------------- F _ 1 ----------------------------------------------------------------------.--------------'------------------------------------.-----------------------------------------------------------' -------------------------- _ r t -------------F------------- -----------f------------------------------------- ------------------------------- DateFINAL INSPECTION '.--/�' --/-------------------------------------- -- AOAQUIN.LOCAL HyE .ALTH..DISTRICT' 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Collfornia Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 3M 3-'63 F.P.E17. i'