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FOR OFFICE USE: �T 'v Permit No. _.__ . - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT `��d -------------------------------------------- ---- ------- (Complete in Duplicate) Date {sued --�----�"-�-� ----------------- -------------------------------------- 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. ,„ JOBADDRESS AND��L}}OCATION--__ 1,; .- ------- ------ ---------------'-------------------------------------------------------------------- Owner's Name T.. - *'" ---------------•--------------------------------------------------------- Phone ; Address------------- Contractor's Name-- - = Phone...------------------------------- .� Installation will serve: Resident/eApartment House ❑ Commercial ❑ Trailer Court [:1Motel E] Other El Number of living units: 1---- Number of bedrooms --%Z Number of baths -./.. Lot size -- � ------------------------- Water Supply: Public system`[ Communify system ❑ Private ❑ Depth to Water Table Stift. 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;K FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t r 6 o tTa k: Distance from nearest well-----------------Distance from foundation-..------------/___.Material--------------------------------__.----------_-_. ,...t.__. � .. t ._.- � _ .. No. of compartments---------- - ---- 'Size-------•------------------------Liquid depth--------------------------Capacity------------•---------- Fi d: Distance from nearest well-------------- I Distance from foundation--------------------Distance to nearest lot line-----------------�� Number of lines---------------------------------Length of each line------------------------------Width of french------------------------------------ Type ------------- ------Type of filter material----------------------- Depth of.filter material----------_----.---_-_-Total length-------------_---_------_---_- __-----_-- I Seepage Pit: Distance to nearest well/3-S__._ Disfanc om f undation_ ..-_-_.Distance to nearest lot line Number,of pits----- -------- Lining material ----Size: Diameter----,3.3-----------Depth------r�,S----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--_-----------------Lining material--.-------------- ------------------- ❑ Size: Diameter ----------------------Dept h---:"!---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------.-.�. ❑ Distance to nearest lot hne------------------ -------------------------------------------------------------------------------------------------- ------------------ Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------- ra I/ ------1.4fZ-------- / ----------------------------- -----------------------------i---------------------- -----------------------•------------------------------------* .---------------- -------- i ------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here6y if that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to aws, and r fes and gulations of the San Joaquin Local Health District. (Signed)--------- -- - ---------------- . ----------- � and/or Contractor] jj . . ---------- ---- ----- c�'�----------------------- (Title) • By: ---- . - ------- &_ ___,,j(Owner ----------------------------- - ----------- - (Plot plan, showing size of Iot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). f i FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY------0,--- ---- ---------------------------------------- DATE----4�- -` ------------------ ------------ REVIEWEDBY-------------------------------------------------- -----------•-----------------------------------------------------•---•- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------- -i-------------------- ----�f v- ----------------------------------- D_ rE--- --•--------------�------;--------------------- -- Alterations and/or r mend_atio --Lh`,.% --- '------- - -- ------- ---- ----------- ----------C:- -. • �' ¢' ( / --- ---- - lc.N -d Q C"Q1�� !f --------ect. -c<-,d* --- ------ --------- a 3' : .. ti -----U4- E!. f' e 1 FINALINSPECTION BY:-----��-} �- -•------- •------------------------ ate--...-W---- -----i------------------------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Flazetton Ave. ` .300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 311A 3-•63 F.P.CO.