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FOR OFFICE USE: 2 i - ----------------------------------------- --------------- ------- -------------------------------- ---------------------------------------------- .---_-___ APPLICATION FOR SANITATION PERMIT Permit No. _.l.7 -------------------,--------------------- ---------------- (Complete in Duplicate) (v --- --------- This Permit Expires 1 Year From Date Issued Date Issued __ -- © — ?o— ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install f e wor9k herein desc,l d. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_. - -- -- ------ .-.-------------------`------------ /----------- Owner's !Owner's Name-----"-- . 'Phone Address-_ --lV .----- -- .--•••-......--�3----- ------ -- ---------------------------------------------------------- Contractor's Name- ----...-.---•-------••-----------F--------------------------------- -------------------------------------------- Phone----------...---•------------------ Installation will serve: Residence, Apartment House ❑ Commercial ❑ jTrzifler Court ❑• Motel ❑ Other ❑ jo'Number of livin units: . -_.- Number of bedrooms -__7_ Number of baths _ ---_ Lot size _-- -. g 1-:' ------t-1....-a Water Supply: Publics stem Community system Private De fh to Water Table Q PP Y� Y ❑ Y Y ❑ L�] p �-� ft. t Character of soil to a depth of 3 feed: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Pfl Clay ❑ Adobe ❑ Hardpan$J 4" Previous Application Made: (If yes„date---._-----------------) No 5 J New C6nsfrucfio'�: Yes. D No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within.200 feet.) I if 1` Sepfic Tank: Distance from nearest well__J- ------Distance from foundation,f-/-P---------Material------ ------------------------ - - No. of compartments-.-- ^---------------5ize--9_ "__ -_ -- ------Liquid depth------- -------.--_-----Capacity---��a_-_._-_- Disposal Field: Distance from near t weil_�C�--- _Distance from foundatyion�1 b___---_---.Distance to nearest lot line_�i----_-- Number of-lines..-:_----_-- -------------- Length of each line--- j7-'---.--_-_- Width of trench-.�-_ -p----..----_-----.- m Type of filter ma'teri. /' -Depth of filter material-- �I _""-----.Total, length---7c-_---_------------------------ IIf Seepage Pit: Distance to nearest well-,/!"--,_.___-Distance fromjfoundationI b...........Distance to nearest lot line__ Number of pits--f_--- ----. Lininmaterial _ f •d / -.-- --- Size k Diameter , De th--,' -------------------- y Cesspool: Distance from nearest well_---_-_- __Distance from foundation _;-----------------Lining material-------------------------------------- El Size: Diameter------ ----------- -----------------Depth-------- --------------------------------------Liquid Capacity-------------------- ------.gals. Privy: Distance from nearest well__ ---------------------------------__-- Distance from _ snearesf building--------------------------------------- ❑ Distance to nearest lot line-- --------------------- F' ---------------=--------------------- Remodeling and/or repairing (describer ----------------------------- ------------------------ --------------------------------- <tI E f 1 a:�` -----------=----------------------------------- ---------- - _.. -----------------: --------------------------------------------------------- ------ ---------------------- -------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. { (Signed) = ------------------------------- ----------------------------------------------- and/or Contractor) Y -----------------------------•------------------- (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, --------- DATE--- - s - -----. DATE------------------------ F REVIEWED 13Y----------------------------------- --------------------------------------------------------------------•------ - -------••------------------------- BUILDING PERMIT PERMIT ISSUED--------------- -=- ------ -- ---------- --------------------- ------ DAT Alterations and r recommend tions..,-_°-- -- ------------ �► --- ------------------------ .. / � . -!� ` -- -- --- - lLz�c.. Yt --- u ! ...-..:. ---*-------------------------------- I FINALINSPECTION BY----- - ------------------------- ------------------------------ Date--- - ------------------- ----•----------------------------------------------- SAN 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 ES 9 REVI5EO 8-59 3,d 3-'63 F.F.CO.