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FOR OFFICE USE: ------- -- -------- ------------------- ----------------- - APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- (Complete in Duplicate) Date issued ______ __t c`,�- I__ !� // .........................._.._.--_---.-..----._----.... This Permit Expires 1 Year From Date Issued f-_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install f work he in described. This application is made in compliances with County Ordinance No. 549. JOB ADDRESS AND L AT10N (��" .. `U ----- a Owner's Name 1/ --------------------------------------------- Phone Address ---------- --- ------- Contractor's --•-- y� rs �--�------- -- Contractor's Name------- '- -------------------r------------------- Phone................ Installation will serve: Residence Apartme�House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�--- Number of bedrooms,- Number )f baths __/_ Lot size ---------------------------- ------------------------- Water Supply: Public system E] Community system El Private Depth to Water Table ko- ft Character of sail to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam E] .Clay Adobe ❑ Hardpan ❑ 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.) Sg, ticiTa++k- Distance from nearest well-----------------Distance from foundation--------------------Material-----.-------------------.----------------------- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- Disposa geld: Distance from nearest well....7pO_/._Distance from foundation-_-/0_._-_-.Distance to nearest lot �ne---- Number of lines-------------f... _____ ----- Length of each line---------7.S__.<<__.Width of trench.---cry- _-____ ------ Type of filter materia .__ ,.____Depth of filter material_- ,r< --------Total length------- S_------------------------ Seepagya.Pit: Distance to nearest well-.---J__60-- Distance from foundation....../.A-_-`___.Distance to nearest lot line--._—V--o..- b [ Number of pits--------i------------Lining material---�,0---.-- Size: Diameter------a2....r._Depth------_X_---- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- "/t p Size: Diameter--------------------------------------Depth------------------------------------------------- --Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well---------_r--------------------------------------Distance from nearest building--------------------------.------..---.-. ❑ Distance to nearest lot line-------------- '----------------------------------------------- ------------------ I---- ----------- ---------------------------- !� Remodeling and/or repairing (describe):-------------------------------------- - i ------------------------------------------------------------------------------•----------------•--------------------------------------------•------------------------------------------------------------------- -- ------------------------ ----------------------------- •------------------------•------------------------ ------------------------------------------------------------------------------- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules and regulations of a San Joaquin Local Health District. -------- ------- ----------------------------------- wn or Contrector (Signed),----- - -- - - ---_ / ) BY ---------- --- (Plot - . .. { r = (Title) ---- -- - - ----------------- (Plot plan, showing ize of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. _ y �� .. --------------------------------------------------- DATE-_A_--7-�9-4- _ REVIEWEDBY--------------------------------------------- -------------------------------------- ---------------------------------------- DATE-------------------- - BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendafions:---------- ------- -------------- --- -------------------------------------------------•-•-------•-----•--•-----------------•-•-------------------------------- ---------- --------------------------------------------------------------------------------------------------- ------------------------------------------•------ ------------------------------------------------------------- -----•---------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ------ -------------------------------------------- --•-------•-------•------------- ---------------------------------------------------- FINAL INSPECTION BY:.---- -- Z -------------- Date--- -��--- �� , ¢ w - SAN JOAQUIN LOCAL HEALTH DISTRICT ~ 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklonr California Lodi,California Manteca,California Tracy,California FS 9 REVISED 8-S9 3M 3-'63 F.P.CO.