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FOR OFFICE USE: -------- ---- -------- - ---------- ------ --------- , k� ---------- --- ---- APPLICATION FOR SANITATION PERMIT Permit No. ............ (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued -----"-=-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d ' rib d. This application-is made in compliance with County Ordinance No. 549, 4 . :, JOB ADDRESS AND LOCAT ON." " � -fit'• - - - - =�'' � Owner's Name---- -------- . Phone. Address----- Contractor's Name_.------- - �F' y �V.. Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot er F] Number of livingunits: Number of bedrooms �� 'L— / S_ Number of baths - -.-___ Lot size _!-.1� ��: Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tabled'7ft 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 Z?�New Construction: Yes �o ❑ FHA/VA: Yes R4--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we L_'4�� Dista c �om foundati r-- 9 ----------M t�ai.. .L� - `-"-- �r ------ No. of compartments ------ --- - - _�42 Liquid depth--.__ _ _-_----------- Capacity_/�� _Z>__.-- r Disposal Field: Distance from nearer wellr ------ Distance from foundation_ � - _i------.Distance to nearest lot line_1�---.---_, Number of lines_..._ _.___. - Length of each line-�'._. ��_-----1�/idth of trench.�__J Type of filter material " ` p Total length _ ,/ _ �1C�_Depth of filter material__f g .! �',,;.° Seepage Pit: Distance to neatest well_f ' -.._-.-._Distance #r m foundation.. ".,O^_�_--.Di tante to nearlot line__...___" Number of pits.-Z_-_----__-----Lining.,material- ___Size: Diameter '--__--_-_Depth -p_` _ ----- �} Cesspool Distance from nearest wefi_.---------- .---Dis#ance from fobndation----_--.__ 'j --------.Linin materia! ------- -----�"--_- -------- ❑ Size: Diameter--------- ---------- ------------De Depth - ---- - - ----�---- p .------ ---- -Liquid Capacity- -------------------- ----gals. +Y-> Privy: Distance from nearest well.. Distance from nearest buiidin - ❑ Distance to nearest lot line. ____ .--_-------------------- - Remodeling and/or repairing (describe)------------- �"� ' 4 -- ---- ------ - ------------------------------------------------------ ------------------------------------------- ----------- ---------- hereby -----------------------__----------- ---_------ -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - - ------------------- -- ------- ----------- ------------------ ---------------------------------------------------------------------------------- certifythat I have - - d prepare this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------- 't' a C t on ractor) (Plot plan, showing size of lot, location of system ' elation to wells, buildin (Title)__�il iLe si - Y I P g _-.. - y gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------_-------- -------- ---------------------- - - �-d_�_ DATE------ - ---~- - - ----------- ------------ ... ... REVIEWED BY----. ------------------- ------ --- DATE BUILDING PERMIT ISSUED.-------------_----.--_-. ---- " DATE Alterations and/or recommendations:_.......__ _ -- ---- �" --� ------ - FINAL INSPECTION BY:.. ;: - - --- Date__. : ^ . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California ES 9 REVISED g-59 3M 3-'63 F.P.0 p,