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FOR OFFICE USE: ------------------------ ---- --------------------------- 41 [� '----- APPLICATION FOR SANITATION PERMIT Permit No. ._.1..l,!�f_--'`... -•- ------------------- ------------------------------------- (Complete in Duplicate) (p Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herl-tie fbin descd. This application is made in compliance ith County Ordinance No. 549. Zx ev f7 JOB ADDRESS AND CATIONzt- 1 c sz Owner's Name ------------------------------ -------------- ---- -- --r --- ----------------------- -------- Phone------------------------------------ Address .... ...... -------------------------------•--- Address 's--- Contractor's Name_-.--•------- ............. .. ......... -- -- ...-..- ----------------•------- Phone--------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel. ❑ Other ❑ i Number of living units: ___/____ Number of bedrooms .__ Number f baths __j_____ Lot size --- --------------- 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 ❑ 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.) Septic Tank: Distance from nearest well__-��...... Distance from foundatio ._.____-�_.�_-.-Mat vial__ -----r______________________ No. of compartments- ---------------Size_ r i ---�--- -- - Liquid depth------- -----------------Capacity---/W-----0-- r Dispos ieId: Distance from nearest well---a►l—Distance from foundation-___I -----Distance to nearest lot I' e�-;^� _ Number of lines______ Length of each line-----�_b_Q-_.______.Width of trench_ ------ ----------------- _C _ ______.________ Type of filter material____ _.,__Depth of filter material__,��_`!______Total length__p�_QG___----____,__________ i Seepa Pit: Distance to nearest well_____ ___Distance fr ndation____ Distance;o neares lot i e----r-.______ . Number of pits----- Lining material__- Size: Diameter__.__ _ . De tl -- -- P� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size: Diameter ----De th------------------------------------------=-------Li Liquid Capacity. . ❑ P q p Y - � - --------••9aIs Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------...----._. Distance to nearest lot line---------r------------------------ ---------- - ----------------------- -------------- ---------------------------------------------. ' 7 Remodeling and/or repairing (describe):--------------------------------- -----------------•--------------------------------••---------------------------------------------- ------------------- ----------------•-•-------•----------------------•------------•------------------------------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------•--•----------------------------------------------------------•------------------------------------------------------------------------------ --------------------------------------------------------------------------------•------------------------------------------•------------------------------------------------------------------------------- ! hereby certify th t I have prepared this application d that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulations of the S- Joaquin Local Health District. (Signed)---------------- ----- -------------- •- ----- --- ------k2lation - -------------------------------------------------------�- er and/or Contractor) By;---------- y---- -- --- (Ti+Ie} =--=_=------------ ----- --••• - (Plot plan, showing size of lot, location of systeto we uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--,,,4-,- -,, -------------------------------------------------------- DATE----� -4 - ------------------------------ REVIEWEDBY--------------------------------------------- -------------------- ------ DATE-----------•----------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.------------------------- ---------------------------------- Alterations and/or recommendations:------------------------------------- -------- --------------------------------•--------•-------•-----•-------------------•----------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------------------------------------- ----------------------------------------------------------------�--------- ------ -----------------------------------------------------------------•----------------- -------/--------------------------------------------------- FINAL INSPECTION BY:.,r�-`f ;�- �------------------ - --BY: -------------------------------------------------- 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 E5 9 REVISED 6-59 3M 3-'63 F.F.CC. {