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�r FO OFF CE USE: A y -------- - - -- - -- ---------------- / JJa � APPLICATION FOR SANITATION PERMIT- Permit No. ------f ------------- ------ / ---- ---------------------I-------- Y (Complete in Duplicate) Date Issued f I--------- C This Permit Expires 1 Year From Date Issued Application is hereby macle�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 AND LOCATON------- - ------•-------- -------------- - ne Y � o _...Owner's Name--"----- _- ----- e---------- ------------------------------------------------------ Address ------------------- Address-------------"-------- - ----------------------------------- .. ..•-•----•---•--••-- -----------� i ' Contractor's Name-------- ----------------------------------------------------------- Phone...................---------------- Installation will serve: Residence *'Apartment House;❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_-_ Number of bedrooms - Number of baths _-- Lot size ____ �_.._. -. •�-----------• l-- Water Supply: 'Public system % Community system❑ Private ❑ Depth to Water Table SIJ. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe Hardpan [3 Previous Application Made: I I f yes,date----------- ❑-------I No New Construction: Yes ❑ No FHA/VA: Yes E] No E] 3 � TYPE OF INSTALLATION"AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i r Tank: Distance from nearest well-----------------Distance from foundation-.._._______.------.Material------. __.._.._.___ __._______....___...__._.-- No. of 'compartments-------- ----------------Size---------- -----------Liquid depth-------------- ----------� Capacity----------------- -------• Disposal Field: Distance from nearest well. --.Distance from foundation.--4D.........Distance to nearest lot line_-�___----.. .�'1 ------------Len line �?I-----------------Width of trench.---- � p Number of lines---------�------ - - Length of each Type ofafilter•material.-Si-/F ----Depth of filter material-.-_/--$---------- otal length------ ___:.-_i ---------- beepaqegrit. Distance to nearest well--!Distance from foundation---/-t?_______.Distance to nearest lot line__ ..__.... Number of pits...._. ---_--Linin material--0 --Size: Diameter -.--Depth--_.--07-47_----------- -- Cesspool: r Distance from nearest well---------_-__tDistance from foundation. ------- Lining material_--_.--_---------------------------- 1 ❑ tSize: Diameter--- ------------------ -------- ------Depth--------------------------- ----------------------Liquid Capacity---------------------------gals. '1' --___Distance from nearest building Privy: ).Distance from nearest well c3 ' Distance to nearest lot fo line I ❑ � I line-- ---------------------------------- ----------------------------------------- --------- -----------•------------ -------------- .e Remodeling and/or reparng ( escre _ -----!:��---------------------------------------------------- I . ,---- .� . - -- ------ s --------------------- ------------------------ --------------------------- - = ---------- I ----- ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, and rules and regulations of the San Joaquin Local Health District. 1 1 Title)- Owner and/or Contract or (Sign } Ii [-- -- ------- -- = (Plot plan, showing size of;lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). .. ); FOR DEPARTMENT USE ONLY L APPLICATION rACCEPTED BY ----- ---- DATE ._ - REVIEWED BY------------------ ' -- -- DATE. BUILDING PERMIT ISSUED------- ------------------- - DATE -' - ------ ---------- --------- Alterations and/or recommendations------ ------------------- / ✓ r -------- ------- ------ t l - �s '1 ti -' - e _' -'---------- —� �f� ----------- _.___ ------------------------------------------ - ---- ------------------------------------------------------------. ------------------- ---- /� 1 ----------- FINAL INSPECTION 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 E5 9 REVISED B-59 3M 3-'63 F.P.CO. i�