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FO OFFICE L+15�: ��"' f / Permit No. APPLICATION FOR SANITATION PERMIT -!•�------ ----- ----------- -------------- ------ ------------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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. :. 4(S-(- 7 d, I-lsr ' . JOB ADDRESS ANY-e OCA I -N---- -- ------ - -- ------'�`�' �.(r --- ---=----•--------------------------------------------------- /�� ----- - . Phone--------- Address ------- - Owner's Name- -- ----- - ---fa.�-+•--- -- -- --...-•-----•--•----••--------------------- - ---- ------------------- - - --• Address----- - - c-------------------- - ----------•-----••----------------------------------------------------------•---------------------------------------------••-•-----------•------------ Contractor's Name ----------��- -- ------ ------------------------ --------------------------------------- _ Phone----------------------------------- Installation will serve: Residence Z Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ Number of bedrooms _=!_._ Number of baths Lot size _,/F. 4$------------------------------------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -�t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe tF ardpan ❑ Previous Application Made: (If yes,date--------------------) .No New Construction: Yes 2?-11'.-❑ FHA/VA: Yes ❑ No isP - TYPE OF INSTALLATION AND SPECIFICATIONS: - # (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.��p---Distance from foundation-_le-._____.Mate;ial___(B_f%�f'�_____________ No. of compartments__ r.________________Sizexdex.4�- ,___Liquid depth___ .._________Capacity"'___ `W s J r Disposal Field: Distance from nearest well./.��__Distance from foundatl n__fe___.____.Distance to nearest lot line-46------------ 4 Number of lints------- _. Length of each line----�Q ______________Width of trench,2_-___.__ - S • �; , 'r Vl Type of filter material- Depth of filter materlal__ �____..._,Total length_ __d __0-1 �___________________ 6 Ile Seepage Pit: Distance to nearest wall_- ____Distance fro fou dation_-_/rP�_____-Distanc to nearest lot lin _ __.__:._ ta Number of its}_- __.-------- p- Lining material-- - Size: Diameter__.� ......Qepth -_/�'��k,� Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter'--------------=--------------------Depth------------------------------ ------ ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line____________________'_ Remodelin and/or repairing( describe :-----. -- - - - ---- ------------ ---------- ------------- ----- -- - --- ----- - --------------------------------------------------------------------------------------------------------------------------------------------------------------- --------r---------------------------------------------------- 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 nd regulations of-the San Joaquin Local Health District. (Signed)-------------------- `T° ------{fir Cantracto _ By:.----------•......... ----------------------------------------------- - ---- - -- - --------------------(Title- - (Plot plan, showing size of lot; location of system in tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY__-..__.____ --- ��"'�� f ---- DATE--- v ----------------- REVIEWEDBY-------------------------------- ----------------------------- --------------------------- ------- -------•------------ DATE------------------------ --•------------------------------- BLIILDING PERMIT ISSUED ------------------- ----------------------- DATE. Alterations and/or recommendations:-----��. .---------�-�--- -----�c-1c'z----=-�•--•'------------6'-`---------• ---------------------��=�-------�-�------ . -----•----------------- ---- --------------------------- e ------------------------------------------- •----- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ------------- -------------------------- -------------------------'------------------------ ------------------------------------------------------------------------------------- FINAL INSPECTION BY:.._.._C d'---------`-------- ------------ ., 1. Date y --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California c � E5 9 REVISED 8-S9 3M 3-'63 F.P.CC.