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FOR OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. Z ...._._- �_._ --------------------------------------------------- -- - (Complete in Duplicate) -- -- --..-. This Permit Expires 1 Year From Date Issued �� Date Issued /-_/_l -6 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. �3YsQ JOB ADDRESS AND CATION:ZIA ____ -J- -1_ -_4'e-- -t .Z - * — fib?-LZc7-1-5 Owner's Name-.-.-,k= . -mss. - -�= Address - /- � to ---- - -------------------------- Contractor's Name- ��-�- il-__..._..f ' ---------- --------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� v ` Number of living units: -_�-__ Number of bedrooms r7: Number of aths _ Lot size ---- -- - ----r- --------------------------- Water =:_.---------_-------_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobe❑ 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.) (''� r Septic ank: Distance from nearest well--C7.V__r-_Distance from found tion____/q-------Material----------- --- ----------------- - ` No. of compartments--_______7'--------Size _ ° __ _.Liquid depth___jL___----------------Capecjty--/�-Q Dispos Field: Distance from nearest well-AL, _-__.-Distance from foundation.---/-4.----__--.Distance to nearest lot line-S_-..- __--- ..........of lines-------- �---7---------Length of each line---1{1.f)-----.-._--_.--Width of trench-.-_�_-___.-------,._-------- Type of filter material--__._.�R---f--_Depth of filter material------ __�'---..Total length----_r _�'-a---------------------- Seepa a Pit: Distance to nearest well------- -_-_Distance f m foundation____--�_C5_-----.Distance to nearest lot line--S-- Number of pits...---2-..-_---_Lining material-_---- .? ��-..---Dept --------------- ---.--Size: Diameter__------, Cesspool: Distance from nearest well------t-,-t__.__Distance from foundation--------------------Lining material--_-_--------------------------------. ❑ Size: Diameter---------------------t--------- -----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ----------i---------------------_-----__---___,Distance from nearest building----------_-_____-.__-.___.-_---_____. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------•-------------------- Remodeling and/or repairing (describe) ------------------------------------------------------••---------------------------•--------------------------- - -------------------------------------- - �------------------------------------------------ ---------------------------------------- . . -------------------•-------------------------------•...------------------------••--=-------------------------------------------------------------•-------------------------------------------------------------------------- _I r ----- -----------------------------------------------------------------------------------= ------------------------=---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the:work will be done in accordance with San Joaquin County ordinances, Sfatlwwk, and rules and regulations of the San Joaquin Local Health District. z (Signed)-- ------- r--and/or Contractor) By: y `'("1 -- - ---------------------------------------(Title)------------------------------------------ --- (Plot plan, showing size of lot, location of sysP��tem in r ation to wells, buibings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- --- --------------------------------------------------- DATE------/�- --.. ----------------- REVIEWEDBY--------------------------------------------- ----------------- --------------- ---------------------------------------------- DATE------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ---------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------- -------------- ----------------------------------------------------------------------------••--------------------•----------- __--------- - --------------------------------------- -----------•------------•-•-------------------------------------------- ••----------•------•--•------- ----•------- -•---•---•------•---------•-•--------- -------------------------- -------------- -------------------------------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------------- ----•------------------------------------------------ ----------------------------------------- ----------------------------- - - ------ ------- --------- ------------------------- --------------- ------- ------------------------------------ --------------------------------- FINAL INSPECTION --•-- ------------- Date----- -------------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,CalifoTnia Tracy,California E5 9 REVIBED B-59 31A 3-'63 F.P.CD.