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FOR OFFICE USE: --------------------- -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _Q Q�......... (Complete in Duplicate) Date 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. fQa� / JOB ADDRESS AN CATIO -_�frfG _-- --_> __ . � `__ ` ___..._.'�`°`4-SI L=-�` --- - -' Owner's Name-----Rx - --------------------------- - --------------- ------ -------------------- Phone-----------•------------------------ Address-----------Y//----- �- Contractor's Name--------- --------------�. ......-------- c-•---- ------------------------ ----- ---.-. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial [] Traaiilerr Court ❑ Motel ❑ Other ❑ Number of living units: t.----- Number of bedrooms_ Number baths /--_ l.ot size ------------------_..__-_-.---.-_-_------------__-_------_ Water Supply: Public system ❑ Community system ❑ Private Number o Water Table -------- 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 ❑ 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.) Septic ank_v Distance from nearest well_-__-�e__-_Disfance from foundation----/_._0------.-.Material ___ .-- ------de --n No. of compartments---rg----- ...Liquid depth----�________________Capacity-l-a`2..DQ f Dispo,Sdf'Field: Distance from nearest well.__....... Distance from foundation ---�U�_-___Distance to nearest lot lines-if-1- ----------- Dis Number of lines----__.-_-_�--.-.--__ Length of each line-/�'Q---'__7_D_--24--.Width of french--- -.-_.--_ ri D Type of filter material----�� -Depth of filter material------ �___------.Total length------ Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line----------------- 0 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- !� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.-..--------.-----------.-.-------- 9 ❑ Size: Diameter--------------------------- ----------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------- - from nearest building-----..--_-_--------_---_----..--.--____. ' ❑ Distance to nearest lot line------------- ---------------- ---------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- -----------=:--------------------------------------------------------------------------- •--- --------------•---------.-.....------- ----- 0 ------------------------------------------------------------------•----------------------------------•------------------------------------------------------------ ------ 0 ---------------------------------------- --------------------- -- ---------- --------------------------------------------------------------------- ------------------------------- -- -- - ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. (Signed)------------9__L&� ----- -------- ------ ---- - ---------------------------------------------------- ------------------------------------ nd/or Contractor By--------- 4----- ---------- ------ -------------------------------------------(Title)----------------------------- --------- --------- --... (Plot plan, showing size of lot, location of syst m in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - ---147-- ----------------------------------------=--------- DATE---- -- --------------------------- REVIEWEDBY-------------------------------- ------- --------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations---------------------------------------------------------------------------------------------------•------------------------------------------------ ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------•-----------------------------------------------------------------------------------------/--------------------- ------------------------------ FINAL INSPECTION BY:__ _ 'I> Date--..l� +- ._-• --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haaelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California C5 9 REVISED 6-S9 31A 3-'63 F.P.EO. k •