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F��FFICE USE: yj - -------------f U 7f �� ------ / - - ---------------------- - ----- APPLICATION FOR SANITATION PERMIT Permit No.,�/- -Ax----------------------------- -------------- ---- ------ (Complete in Duplicate) � Z� --------------=----------------.----------_...___.___..._ 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 Ordin ce No. 549. JOB ADDRESS AN LOCATION_-__��- ---_w_ �-tl - � ---------//------- ----- ------ -- Owner's Name__ _ ,_ ---------� ------------- - ------- Phone----1/6 Address---,9?°/r--•----_�---- •--•- Z ,�r Contractor's Name----------- ----------- ------------•-•----------------------- Phone___!_oj(�_`q?. 7 Installation will serve: Residence Apartment House ❑/___ Number of baths _ _____ Lot size _ __Commercial E] Trailer Court [-] Motel E] Other E]Number of living units: /---- Number of bedrooms _! ,� sJ __ Q Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 45.V- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX1 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No 10 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t nk: Distance from nearest well-----------------Distance from foundation-------------------Mater ial__._.-------------------------------..-.--------. No. of compartments--------•-----------------Size-------•------------------------Liquid depth--------------------------Capacity--•-----------------•-- d: Distance from nearest well At-Distance from foundation--./®______.Distance to nearest lot line-__-IS--.------ Number of lines__________________ Length of each line____-�Q--------------.Width of trench..__,�_y -'_...___�____._ Type of filter material_3�. _._Depth of filter material---Ag.-_......---Total length----------------------e.- ____---. U Ul Distance to nearest well-/2-qYw-----Distance from fo ndation__�P.__._..Distance to nearest lot line----_✓�___------- 0 Number of pits--------/-----------Lining material_' from X, .Size: Diameter---13-3--_---------Dept h-----._ _ .--._._---.-- N 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.----------------------------------------- 00 ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------•---------------•----------------------- "1 >p Remodeling and/or repairing (describe):------------------------------------------------------------------------------------ r ---------------------------------------------------------------•--------------------------------------------------------------------------------------------------.-------------------------------------------- ---------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- -------------------------------------•-----•------------•-----------------------------------•-----------•--------------•----------------------------•----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a laws, and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed)----- --- ------- -----&J-- ----------------:--- ---- ( ) B : --------------------------- Title (Plot plan, showing size of lot, location of system in relat' n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --.-- ----------------- DATE------ G --- REVIEWED BY---------------------------------- ----- - ------- -- DATE---------------------------------- BUILDING PERMIT ISSUED------------------------.-_-_-_----------�- ----- DATE 'Alterations and/or rrcommendations:__.___ -------`--- -------------- --------- ------ - =t---- ` f--- ---------- -------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------.- ----------------------------------------- ------------------------------ 414 FINAL INSPECTION BY:..- ------ -- -----l-2 _--------- Date------------- ---_`�-- ----- ----- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:olton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street g' Stockton,California Lodi,California Manteca,California Tracy,California £5 9 REVISED B-59 3M 3-'63 F.P.CO.