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FOR OFFICE USE: ----------------------------------- • . w. . _ ,ryr' �- - -z� --------------------------------------------------------- APPLICATION FOR-SANITATION PERMIT P rrtlif-No.-_-_-_-- _--- •-• __-• ----------------- ----------------------------------- - (Complete in Duplicate) _ - - pate_ 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. JOB ADDRESS AND..LOCATION---C --`-- -u✓_1__ll� --L. - ? --r--��.��-f��` --- ----------------- ------ Owner's Name___-- �--------------•--- -------------------- ------ P one-•---------••--•-------- Address--------- -----= �`Z – "- Contractor's Name-------------1 .:.------ ------ �---------.----•------------.----- Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E❑ Number of living units: __�-_-_ Number of bedrooms _'2�Number of baths ._..1___ Lot size ----r7I_i------------------------------------------- J Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ___-_ ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date--------------------) N New Construction,: Yes JkNo ❑ FHA/VA: Yes ❑ NoAr TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se'-RfiTank: Distance from nearest well___'7__e2____Distance�jfrom foundation__-_.'� _____.Materia _ _j No. of compartments-----�—-----------$ize�'_X_�]-_X__._�------Liquid ,,IIdepth------ -- ----=�,�--:Capacity__1--_7._-- -_.-._-- Dispo I Field: Distance from nearest well---�D_-------Distance from foundation___._`T --------Distance to nearest lot ine_1a_________ Number of lines______--___ ______ -_______________Length of each Iine_� _-'. d -.-:Width of trench--- :---.-----------__------- Type of filter. material 5 ) ___Depth of filter material___ £ ---- Total length___._j__5_c�___-___________________ �! Seepage Pit: Distance to nearest well----------------------Distance from foundation_..-----------------Distance to nearest lot line_-.----.......... p I ❑ Number of pits----------------------Lining material-_---------------------Size: Diameter.-------------.--------Depth--------------------------------- � + Cesspool: Distance from nearest well----------------Distance from foundation-------------------.Lining material__._______-____.___________________r. i ❑ Size: Diameter--------------------------------------Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well_ .._ -__.____- _______________________pistance from nearest building_____..._____________.._________._.__..._. ❑ Distance to nearest lot line-------------------------------------------------•---•---------------------------------------------------------------------------------------- Remodeling and/or repairing a(describe):------------------------------ -----------------------•---------------------------------------------------•--------------------------------------------------------------------------------------------- ------------------------------------------------ -- -----------------------------------------------------•-----------------•------------------------------------------------------=-------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and,regulations of the San J aquin Local Health District. St ned -- ------ ------------------- -- ------ -------------- ----------------- - --------------------------------------------{Owner and/or Contractor) By:----------------------------•---•--------------------------------- ---------------- -------- --------------------------------------{Title)--------------------- ---------- ------- -- --------------- (Plot plan, showing size of lot, location of_system.in'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- ,r -•------------•---- DATE-------- -- REVIEWED BY-------------------------------- = -------------------• DATE--C/-? ---- ---------------- BUILDINGPERMIT ISSUED-------------- ------------------------------------------- -•----------------------------------------- DAME-------------------------------- ---------------------------- Alterations and/or recommendations------- --- --- ---- --------------------------------------------------------------------------•-•-----•------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------- -------------•- ----------------------------------- ---------- -----•--------------------------------------------------------------------------------------------------------------- ----- --------------- -- --- ------------- --------------- ------------------------------------------------------------------------------- --------------- ------ FINAL INSPECTION BY:------ ----- -------------------------f- ------------- Date.- ---------------- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon 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 NLA