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FOR OFFICE USE: --------------------------------------------------------- ---------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ------------------- (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. compliant with County Ordinance No. 549. �a _,�; _ wo ow-t dam-- 2 ---- {� -+ JOB ADDRESS L CATIO _ 7v {a.r----•-- -L.- Owner's Na Phone---- ------------------------------- --- - t Address --- ' e i t Contractor`s Name-- i Phon Installation will serve: Residence Apa ent ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ... Number of bedrooms _W_ Number athsc2._ Lot size --- s _.�--X_� '---------`--=--•- Publics stem Commur it system ❑ Private Depth # ater Table ---- ft. Water Supply; Y ❑ Y Y 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: o septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well------ :0_�Dista e from foundationf1 --- -_� -------.Material-------- - i No. of compartments----- ---- -----------` de l h_-- -- ..-..----------Capacity..-� -- Disposa ield: Distance from nearest w it----_ --Distance from foundation.��Q!------Distance to nearest �# line- --- Number of lines---------- ------- ------ Length of each line---76.- _�_.__.Width of french- %_-. -dti.------- -_ T e of filter materia ,f-�_�--_�-_-Depf of-filter material-_ - - --- - __"!---Total length- ��: __441 l5�l / Seepage Pit: Distance to nearest well----------------------Distance from"foundation_--_--.. ---------- to nearest lot line_--.--__-__-.-- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material=-_____-__"---- ----------------- G ❑ Size: Diameter----------------------------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest-well-------------------------------------------------Distance from nearestbuilding----------------------------------------- d- ❑ Distance to nearest lot line------------------------------- ------------------------------------------------------------------------------------------------------ ---- , ------•-------------------------------------------------------------- --- ----- Remodeling and/or repairing (describe):-- -------------------------------------------•--------------------- '- - -- -- ----- ---------------------------------------------------------------------------------------------------- ------------------ ----------•-------- ----------------------------------------------------------- I ---- ----- ------ ------ I herebIcerfiff t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, and rules and regul the San Joaquin Local Health Dis+rice. Si ned = ---- - -- --------------------------------------------- -------------- -- - -- an r tr( g )------ - —�- ;- Contractor). -- .- - d/a or BY= f - -------- -------- - (Title) ` .:. (Plot plan, showing size of lot, location of syst m in relation wells, buildings, efc., can be placed on reverse side). z FOR DEPARTMENT USE ONLY Ile �` -=�5-------------------------------- APPLICATION ACCEPTED BY 2 f ------------- DATE REVIEWED BY----------------------------- - ------- ",. w,`: '-: -DATE-=-.- ----_-.:.- =--------------- 1 BUILDING PERMIT ISSUED--------------------------------------------------------------- ----------------------------------- DATE-------------------------------------------- ----------__-- Alterationsand/or recommendations------------------------ ----------------------------------------------------------------------------------------------•----------------------:---------------- -------------------------------------------------- ------------------------------------------------------------------------------------- -------------------- ------------------------------ ---------------------- ------------ FINAL INSPECTION BY:../,Z44------ -------------------- c Date..-- - �`----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3-'63 F.P.CC.