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FOR OFF US . y._. d �.a ------ _ �- APPLICATION FOR SANITATION PERMIT Permit No. ........... ...... .. --------------------- ------------------------------ .(Complete in Duplicate) 3 Date'Issued ----_-------_------------------------------------------- This Permit Expires.l 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 Cou ty Ordinance No. 549. I rr t - JOBADDRESS AND LOCATION------�I6-----------` _---------------•-.-- '------------------------------------------------------------------------------------------------- + Owner's Name------ -----!�P/-_ Phone--------- -------------- �s '- Address. = ------------------- Contractor's Name--.- --------`-"------ ---------------- Phone - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: _j_____ Number of bedrooms ;2—.e Number of baths ____ Lot size -----,��5.._X10A------------------------------ Water Supply: Public system VCommuriity system ❑ Private ❑ Depth to Water Table ....4?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ S dy-Loam El. Clay Loam El Clay E] Adobe [Hardpan ❑ Previous-Application Made: (If yes,date-------------------- No• New Construction: Yes ❑ No P!r- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk:' Distance from-nearest well-----------------Distance from foundation---------------------Material---------._:------ ------------...._.------__- No. of compartments------------ --------- ---Size--------------------------------Liquid depth--------------------------Capacity---------------------- Dispos Fiel - Distance from nearest well.................Distance from foundation..-_-_--_______--_Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line---------------------------.-.Width of french-------------:--------------------- Type of filter matenial_________________________Depth of filter.material-----------------------Total length--------_-_ __ -_-____-______________--__-__- Seepa Pit: Distance to nearest well--- _--- __--Distance fromfoundation__fd_________.Distance to nearest lot line_____________-____ . f � Number of pits.:_}_.r______________Lining material-_�Q- p -$ize: Diameter '3 De th a- ----- VN - Cesspool: Distance from nearest-well-----------------Distance from--foundation..._---_-__£---_---Lining material------------------ ❑ - Size: Diameter-_' Dept h-----------------------------------------:..........Liquid Capacity------------ --- gals. Priv Distance from,nearest well------------------- ----------------------------- from nearest building _ ...... ❑ Distance to nearest lot line----------------------------------------------------------------------- ------- --------------------- --- ------------------- r ----•- -------------- - Remodeling and/or repairing [descrilae7�--------------------------=------�--- - ------------------------------------•----=----- •----•-------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------ --------------------------------------------------------------- ------ -------------------------------------------------------------=------------•-•• --------------------------------------------------------•--------•-------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, and rules and regulatio of f San Joaquin Local Health District. i Owner and/or Contractor (Signed)-------------- - ------------------------ -------- ----- - - =-----= -�-----------------------------------------------------------------( ) By--------------------------------- ----•- i -----=--------- - - -------------------------------------_--------------(Title)--------------------------- (Plot plan, showing size of lot. Iota on of system in relation to wells, buildings, etc., can be placed on reverse side. 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- C'- _-_._-___ DATE------- -�_f - ------------------- REVIEWED BY-------------------------------------- --------------------------- ------------ ----------------------------------------- ---• DATE-------------------•-------- a ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------_--------------- DATE------------------------ ------------- Alterations and/or recommendation :-_--_-._____-_.-_I_-_---_--_.___ �_ !:� .. -- --------- -- �'` -- -- -----------------•----------------------------------------------------------- --- -------•----- ��- ----------------- ------------------------------- ------- ---------------------------------- --•----- ------------------------ ------------------------------------------------ --------------------------------------------- FINAL INSPECTION BY:------ -.C..=_f - d--'------------------� Date------- ................... ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISM 8-59 3M 3-'63 F.F.CO. f