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FOR OFFICE USE: 7-------------------- APPLICATION FOR SANITATION PERMIT Permit No. _- ------ ------------------------- ----------------- :�- _._ _.-_ - . . .. (Complete in Duplicate) t '............. This Permit Expires 1 Year From Date Issued Date Issued ------ JrS__ Application is hereby made to the San Joaquin Local Health Dist#ict 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 iLOCATION_-- '14/0 _! '-_.- ----- ----------------------•--------------------_-_-l---`-----�-----f---'-r ----------- - PhoneOwner's Name . Address------•-•-- t�- � Contractor's Name______./-- -----------•- ---------•--•---------------------------•------- • ---------------------------•---------•-•----------------•------ Phone_.............._..----•----------- Installation will serve: Residence U--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ,_____ Number of bedrooms __-7�Number of baths ----- Lot.size ----_ ___.--.__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam ❑ Clay E] Adobe ardpan ❑ 4 Previous Application Made: (If yes,date?-------------------) No New Construction: Yes �lo❑ FHA/VA: Yes ❑ No�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tan :' Distance from nearest well_nstance from�foundVion----1_�------.Material__ 0��_____.--._-- ---- �_.. No. of compartme'nts_--___� --------Size_ -X-T_� .___Liquid depth__.--_ �..___-__Capacity_ � . Disposal i6ld: Distance from nearest well EBistance from f�urydatiof__�/ r7 Distance to nearest ]of ine___ ___ r Number of lines.-_--____ --- __-_l___Length o(e7a h Ilne_ U_ " �' Width of trench____.--�:��____________- Type of filter material___ y�_ -_-Depth. of filter matenal__� -----------Total length_-___.1_4-_P______________________ W Seepage Pit: Distance to nearestwell------------------t__Distance from foundation--------------------Distance to nearest lot line----------------- i ❑ Number of pits------'---------------Lining material-----------------------Size: Diameter----------------- Depth----------------------------- I Cesspool: Distance from nearest wel!_________________Distance from foundation------------------- Lining material------------------------------------- ❑1 Diameter---- .__=' - ------'---- De th------------------ -- P : Liquid Capacity ------------------------•-gals. Privy: Distance from.nearest well-_.__-:..___-_.- ._Distance from nearest building _--.____-_-____-_- ---- - --------------------- ❑ Distance to nearest lot line---------------------------------•------------------------------------- ------ ------------------------------------------ Remodeling and/or repairing'{describe) = ---------------------------------------------------------•---------------- ------ - ------ tD ------------------------------------- ------------------------•------------------------------------------------------------------ -------------------------------------------------------------------- -- - ------------------- -----------------------------------•----------------------------------------------------------;--------- --------------------------------------•-------------------- = ------- ----------------------------------------------------------------------------------------------- ----------- - I hereby certify that I have prdRared-this'application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of,*e San Joaquin Local Health District. - ------------------(Owner and/or Contractor) a BY - 11 -` :------------------------------------------ -`------------------------(Title)--------------------------------------- - .............. (Plot plan,;showing'size.of lot, location of system rin:relation.to wells, buildings; etc.,-can be placed on reverse side). � t FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED $Y__ _ � DATE----- t 1-.�} / ------ -- ----------------- REVIEWEDBY---------------------------------------------' -----------------------------------------------------------------=------- --. DATE----------------- ------------ BUILDING PERMIT ISSUED----------------------- = - - DATE---------------- --------------- ----- Alterations and/or ree~ammendationi:-_.____� _ ------------ _ r----------- c� --• -- - -- -' -------------------------------- -- _ - 3- � r ---- ------------- -------.- . -° �i .. - -- ----- -.------ ------- r 9 ----- ----------------- ------- --------------- --- - ------ -------------------------- ------------------------ ------ ------ -------------------------------------------------------------- -------------------------------- FINAL INSPECTION BY:_ rJ a- _ ------ Date- ------- 6' - ' OAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CG. I