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FOR OFFICE USE: -- ---- -- _ _ _'__ ____ APPLICATION FOR SANITATION PERMIT Permit No. __f .`.... t (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 described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION/J ✓c__y -C --- --- cr ,.-------'y ` `` == -------- Owner's Name---- 2x1 -' � c i------ ------------------------ ------------ -------- -------------- Phone---------------------------------- Address - C :� _ :`5c ---- -----------------------------------•------•---•------------ - Contractor s Name---- -----�f�--��- - -.-, '.�.�:�--------�--- --------- -------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑!!Commercial El Trailer Court El Motel 1-1Other Number of living units: ---/__ Number of bedrooms ?/- Number f baths -� Lot size __.�� '_.4_F -------------------------- Water Supply: Public system E] Community system E] t, Depth Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe Q Hardp n Previous Application Made: (if yes,date_ ------- ) No,( New Construction: Yes RNo ❑ FHA/VA: TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septicank: Distance from nearest well._:_- Disfan ce from foundation- /.r .........Material__.. !d_ - r_r_._____.................. No. of compartments____ ________________5ize __X :-__Liquid depth____` ... Capacity�F Dispo Field: Distance from nearest welL_:er-c_____Distance from foundation__/C----__.__.Distance to nearest lot line---- [ Number of lines_..._-' ___._.. Len th of each line_#S� .7LI_L' E '— 9 - --- - -- Width of tTench...�.-----�------",�--•---- Type of filter material___�!_._ _t__Depth of filter material....../--_ .__.Total length_______ ____ Seepage Pit: Distance to nearest well._.__._._..._.-------Distance from foundation---------------- to nearest lot line_.............. ❑ Number of pits.... ..Lining material------------------ ----Size: Diameter_.-------------------Depth_..........-..._-..------------.- _r Cesspool: Distance from nearest well----------_......Distance from foundation----- --------------Lining material-________..----- ----..______- ❑ Size: Diameter-------------- - -- - ---- --- ------Depth----- ----------------------- --- ------------ -Liquid Capacity. .-------------------------gals. Privy: Distance from nearest well,_.. _____________________Distance from nearest building...___.-----------------------..-..---... ❑ Distance to nearest lot lire. ._ ------ ------- ----- ----------------------------------- -- ------ --- ---------------- ----------------------------- Remodeling and/or repairing (describe}---- ---- ---------- -- - ------- ---- --------------------------------------------------_---- ------ ---- ------ - ---- --- -- ------------------------------------------------------------------------------------------------------ --------------------------------------._...----------- - .- .-- I hereby cer ify t at I have prepared tapp' n and that the work will be done in accordance with San Joaquin County ordinances, Statend rules andbreul,,Xons of the n Joaquin Local Health District. Vref4ion,fo (Signed)--- - ----- � -- - - ---- ..----------------:----...- ---- --------- --------------= -- ------ ----- ------- ------- ------ ----- ---------- - -(Title)---------.-.--------- - - -- --- ------ --... .- ---- --- ---- (Plot plan, showing size of lot, location of systeells, b ildings, etc., can be placed on reverse side). FOR DEPARTMEN USE ONLY APPLICATION ACCEPTED BY-- � .. .. r=` ------ DATE-.-----.-.'-,t . - - -- '----- - ------ --------- ------........ REVIEWEDBY---- - --------- - ------------- --------- - - --------- -------- ---------- DATE.------------ ------------------------------------------ BUILDING PERMIT ISSUED------------- ------ ----------------------------------------- ----------------------------- DATE----------------- --------- ----- Alterationsand/or recommendations:----------Irl---- ------ ------------ - ------ -- ---------------------------------------------------------------------------------------- ----------------- - , FINAL INSPECTION BY:_ :' -: ' -------------------------- Date !��i ; SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.Cq.