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FOR OFFICE USE: APPLICATION FOR FOR SANITATION PERMITPermit No. ----------------------------------------------- ---------- ------------ - - _-.-------------------------------- .(Complete in Duplicate) Date-Issued ------------------- --------------------------------------- This Permit Expires I Year From Date Issued 2-30 1 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 AN LO ATI N :. -'' _rte-* ��J�,r�.'t'--�- �r �---- -------------- . _ Owner's Name ---. Phone--------------------•--- ------ t ' Address �- " -------------------------------------•--•--------------------------------- Contractor's Name-------------Orr-sl>1,_a.r-�_ ------_----•=------------------------------------- •---------------•--------------------------••---- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial '❑ Trailer Court M 1 ❑ Other '. Number of living units:,____ Number of bedrooms _= Number of baths ___ --_ Lot size ____G�ot_____________ __ ________.____ Water Supply: Public system ❑ Community system ❑ Private k Depth to Water Table __4--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date........_-----------) No [X New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C Septic Tank: Distance from nearest well....6_!0----Distance fro fours at• ____/p_ -___.__.Ma e�L _ ______ No. of compartments____��-----------Size____r _g-__ __ ._ Liquid dept h____ _� . ....-_Capacity.. �3+------------- Disposal Field: Distance from nearest we-Ih_ ------ Distance from foundatipn� __--_.Distance to nearest lot line.______________ {/} f Number of lines------ /- Length of each line____-1-____j_._ �r_____.Widfih of trench___________________ A.: Type of filter material-_-_-_ l._� Depth of filter material___1__ ------------Total length_____l��________________________ Seepage Pit: Distance to nearest well_______--------------Distance from foundation---------------------Distance to nearest lot line-------._________ ❑ Number of pits----------------------Lining material--------------------.--Size: Diameter------------------------Depth----------------------.---------_ op Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material------._----_____.________________ Size: Diameter--------------------------------------Death--------------------------- --- ---Liquid Capacity------------ -- ---------gals. ��.+-.s•e:: - -s^�,�+��-Tom--ter �;,....-.+e-�.•r..,�-,.. -+„ -n..�. �. .� Privy: Distance from nearest well-----------------------------------. ----....Di`stance from nearest building_____. ------------------------------- El -_-__________________.._--.❑ Distance to nearest lot line--------------- -- --------------------------- ----`-------------------------------•-------------------------- ----------------------------- b r t Remodeling and/or repairing (describe)--------------------------------------- ----------•---•-----=----------;------- --------•--------------------------------------------------------- ---------------------------•-•-•------•----------------------------------:------------------------------------•----------------:-----------------; -------------------- ------------------------------------------------ -------------------------------------------------------•••-----------------------------•------------------------------•------------------------------------------------------------------------------------------------- ------------------ --------------------------------•--------------------------------••------------------------------------------------------------------------------------------•---------------------------------- I --------. .1 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 and regulations of the San Joaquin Local Health District. ' - = (Owner and/or Contractor) (Signed)-------- -f- --- - -- - - ----- =- . By- R� - -! -- ---- - --- � -----------------------------------------(Title)------------------------------.---------- --- ------ (Plot plan, showing sizeoflot, location of system in relation to wells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------- -------------- -------------- -------------=-- ----------------------- DATE-------------------- --------------------------------- REVIEWEDBY------------------------------------------------------ ----------------------- r--:----.----------------- - � ' DATE - � /f�--�------�� BUILDING PERMIT ISSUED----------------------------------- -------- -------------- --- �'f DATE --------- --------- Alterations and/or recommendations---------------------------- --------- ------- ------- --- ----.--------------•------------------------------------------ -- ----------------------------- --- ----------------------------------- --------- ------------------------------------- ------------------------- rf ----------------------------------------------------- --------- �- -- ------------ - - ------- --------------------------------1 ------ -----------=------------------------------------- ------ ---- - !------------------------- -----------•- .-�-------- --------- - ---------- ----------------- FINAL INSPECTION BY:.----f .------ -=-•------ --- -�- Date �. ----------------------------------- FINAL JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �$ 9 REVISED 5-59 3M 3-'63 F.P.CC. � ,.