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bR OFFICE USE: I !_� - -'' �! 7 APPLICATION FOR SANITATION PERMIT Permit No.. ._7-y.. .. ----- -------------------- --------------------------- - {Complete in Duplicated // _ Date Issued ---..l---..._IG y -----------_------ ---------------------- --------- 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 in the work herein described. This application is made in compliance with County Or inance No. 549. le JOB ADDRESS A DLO. N l-- -l-- --�'--------- a' - Owner's Name .--- -.. ' .. Phone. R. Address------------------- ---- -- ---------------------•------- TIContractor's Nam Of•--- Phone — .---- Installation will serve: Residence partment ouse ❑ Com ercial ❑o Trail ourt [-] Motel ❑ Other ❑�, Number of living units: .-_--- Number of bedrooms ��Number of baths - .__ Lot size ---,- 1 -- -- -/---� •--------------- Water Supply: Public system munity system E] Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ A obe ardpan ❑ Previous Application Made: (If yes,date................._.) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPWINSTALLATION AND SPECIFICATIONS: No se�tic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tan Distance from nearest well-----------------Distance from foundation----------..._.----Material.....-..----_-..-.--------_------.._....-.___. No. of compartments------ ------------ -----Size--------------------------------Liquid depth--------------- ----------Capacity----------- �^+ 41 D• sal I ante from near st well.N04_eDistance from founclation..�..r--- _.Distance to nearest lot line...r -..... Number of lines.----t..... ............. .......Length of each line (�-_r------------Width of trench �----------�-- � -�"`'t ---Depth of filter m terial----- _._..------ gth-----_------------- �• / Type of filter material �� Total len �Tr nc from foundation....... . ......Distance to nearest I line------1. Seeps a Pit: Distance to Weare t well_ Q (. _-Distance �� Number of pits__ Size: Diameter-----... -.. Depth__-,'7___V .-_---------- ----------------- Lining materia. Cesspool: Distance from nearest well.................Distance from foundation _------------.-.-.Lining material------------....__....._--------_.-. ❑ Size: Diameter---------------------- ---------------Depth-----------------------------------I----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----__---------------- -----------------------Distance from nearest building-_---.... ..------.-._....----.---------- ❑ Distance to nearest lot line----------------- --- -------------- ------------ ------ 3Y ------------------------------------- Remodeling and/or repairing -------------- --- ------------------------- --•--------------------- -------------------- ------ G• --------------------------------------------------- --------------- --------- ---- -- --- ---- ----` ------- -- ------- ---- - ---- - ------- -- --- ------ -- --- -- ---------- -----------------I----------------------------------------- ------------------------------ ------ ----------- ----------- -------------- -----------• --------- ----------- - ------------ I hereb r i xY�that pre ed is applic 10 t t the work will be nem cordance with San Joaquin County ordinance a airs, rules`"and reg s_o# San qui Lo al a District f (Sig -- -- -------- j- ---- - --- ----- --- �' �� Contractor) BY------------------------------------------------------- ------------------------- -- •-- --- - - - -- - - - ----- ----------------------- -------------- ----------------- (Plot plan, showing size of lot, location of system in relation uildings, etc. an be place n reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED �BY_____ --- -= --. ✓ - ----------------- DATE------------------------------------------------------------ REVIEWEDBY-------------------------------------------------------------------- -- -------------------- -------------- ---- DATE - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------. DATE----------------------------------------------------------- Alterationsand/or recommendations:------------------------- ---------------------------------------------------------------------------------------------•--------------------------------------- -•-•---------------------•-------------------- _------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------- ----------•------------------------------------ --- ----------------------------------------------------------- --------------------------------------------------------------- ---------------•----------------- ------------------------------------ ----------------------------- -•---------------------------------------- --•------------- ----------------------------------------------- ----- ------------------ -----------------------------r-----------------•----------------------------------------•-•------------- -------- ------------------ --------------------------------------1---------------------------- FINAL INSPECTION BY:..... ..- _ _ Date - -- -- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street Stockton,California Lodi,California Manteca,California Tracy,California 95 9 REVISED 8-59 3M 3-'63 F.P.CC.