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SE:-- FOR OFFICE USE- --------------------------------------------------------- -- ------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. /_ ..lP.. ...7 (Complete in Duplicate) s 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. JOB ADDRESS AND LOCATION-------------------------- , 9�`- ---------------------- 0 Owner's Name - ----------- ��LL------ - ---------------- ---- ----------- -- ------------------ Phone------------------------------------ Address--.:- �-- - - --- --------� ---T -------------- Contractor's Name--•-----•------ ------ -•-- °. -------------------------------------••---- - ------- -------- Phone.---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms -;__�- Number baths .y�Lot size _________________________________________________________ Water Supply: Public system ❑ Community system ❑ P�rivate..�De;,�Iay Water Table _------- ft. Character of soil to a de th of 3 feet: Sand Gravel Sand LoamLoam Cla Adobe HardpanP ❑ ❑ Y ❑ Y ❑ ❑ ❑ 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.) r Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-------------------------- ❑ No. of compartments------------ -----------Sizer--•--------------------------I---Liquid depth----------- -- ---------Capacity.:. - -------- I Dispos Field: Distance from nearest well___S .-__-_Distance from foundation...Id_._.-------Distance to nearest loth ine_S___________ Number of lines--------- Length of each line___�___�__r�_._.Width of trench_-//2-____�._________________ Type of filter material_ _ _._ Depth of filter material___-/-,D G_________..To#al length L.f�-------------------------- ------- -1�; gi o Seepage Pit; Distance io nearest well----------------------Distance from foundation-----------.........Distance to nearest lot line------------------ Number . - . F1Humber of pits----------------------Lining material---------- ------------Size: Diameter-----------------------Depth---------------------.----------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-------- -_--k- __.---._________: ❑ Size: Diameter-------------------------------------Depth_---• ----------------------------------------- q Capacity-._ _Li Liquid Ca acit ala. � `- Privy: Distance from nearest'*well_.-.--- >_------------------------------Distance from nearest building---------------------------------------- 0 Distance to nearest lot line------------------------------------------------------------------------------ ------------------------------------------------------------ Remodeling and/or repairing (describe): ___.._....____- k-------------- ------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------------------- - -------------------------------------------------------------•--------------------------------------------------------------------------------------•------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------•-•-------------------------------------------•-------------------------------------------------------------------------------- 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) ------• ---------- ". ►r++et+tP/or Contractor)' BY:-------- ----- -- ------ ----- - (Title)--------------------- ------------ -------------------------- (Plot plan, showing size of lot, location of system in relation wells, buildings,'etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !^ --` {" DATE... ------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------—-------------------------------••---• DATE---------------------------- ----------------------------- - Alterations and/or recommendations---------------- - - --------------------------------------------------------------------------•--------------•-----------------•------------------------------- -------•-----------------------•------------------•- ••-----1--------- ------------------------------------------•--------------------------------------------------------•--------------------------•-------•-------------- ________._.,____________________-____-_______..________..-_____-_________.....______________._________._.-________________._____________-____.____________.___________.____-•______..____.___---._________________.____-_.__ -------------------._..-. .---------------.-- ----- ._-----------.------.--------.--------------------------------------------------------- -.__.--___..-___--__._------.-___._...______________..__________._ ..................................................................................�__d _ ___..._.._______-________._____.._____-____._______ ..____--_...__.___._._.________._.___________.________..__ __ -__._ _____._.________ __._ . __ . FINAL INSPECTION BY:_ • ^", ---- --------- ----•----- Date--Z-A?--,r------- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxdton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 Revisrb a-s9 3M 3-'63 F.P.CC.