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OFFICE USE: _ w r ------------------_-------------------_-----..--------. _ APPLICATION FOR SANITATION PERMIT Permit No. __ —J� ---------------------------------------------------- -- (Complete in Duplicate) G J� Date Issued --�i�-"-°-"� ___________________________________________________ This Permit Expires 1 Year From Date Issued r j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. F This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.. ------ --- ------- ? �- ------------------------------------------------------- r Owner's Name ----- - ---/---------- -------------------------------- Phone------------------------------------ Address---------------------- ' --------------•------------------------------- t �_<q Contractor's Namer---------- -- Phone's Cn1o__ -_--d_-/ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ N� ' Number of living units: _ ____ Number of bedrooms _ Nurr►ber of baths Lot size __. _,��__�� ------------ Water Supply:.Public system E] Community system EltPrivate0 -Depth:to Water Table �.�ft. Y Characfer of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay M . Adobe g Hardpan F] Previous Application Made: (if yes,date-- -------- No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOWmAND SPECIFICATIONS: ; (No`septic tank or-cesspool permitted if public sewer is available within 204t.) ' '�' Septic Tank: . Distance from Weare ` .. st well_ Q__-__-.Distance fom foundation__. D . Material_ __________________ -- �! - No. of<compartments__,�-------------------Size__�,�_, . 3.-Liquld depth_____ _ Capacity/,-9.0-6_ Disposal Field: ,. Distance from nearest well._5_L?--------Distance from foundations-_-------.--Distance to nearest lot line___________--_.- Number of lines____ Length of each line fSr. idth of trench.-.-- _2_�-_ ------------ -- _ _ _ F Total length____________________._c _ !a�__-_Type,of filter filter material__ � j ! t 1 ' 5'e�ge Pit: iw _Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_______._______._ r Number of pits- ---------------Lining material------------------ --'.Size: Diameter---7----------........Depth--------------------------------- N Cesspool: Distance from nearest well-----------------Distance from foundation.-.-___----____-___.Lining material--------------------------- ❑ Size: Diameter_- --------- -----------------Depth---F-------------------------- ----Liquid Capacity ala. P ty---------------------- g Privy: Distance frominearest'well______________________________-----------------Distance from.nearesf building_.__.____-____--__-___"---------------C El Distance to nearest lot line----------------------- - .v --------"I------------------------------------------------------------------ Remodeling ___._______._Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------- ---------------- I~ ---•-----•--••-----••----------•------------------------ -----------------------------------------------------------•---•------------•--•------------------------_------------------------------------------------------ _' 9- 11'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County; ordinances, at laws, and rules and regulations of the San Joaquin Local Health District. , (Signed)------ - ------------- -----_ Owner and/or Contractor)` -------------------- - ---------- - - By: --------------------------(Title)- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - - - i.�°..�------------------------------------------ DATE---- i REVIEWEDBY------------------------------------i------ - --------------------- --------------------------------------------------- ----- DATE------------ •--------------- BUILDING PERMIT ISSUED------------------ ----- q_ Z_ _ r D '�= ----- .�1Alterations and/or recommendations:__-___. ____ �I _ �_. _____ _--- 1 ---- -----------------------=---------- --- --------------------------- -------------------------------------------------------------------------- j. --------------------------------------- -----------------•------------------------------------------------------------------------------------------------------------------------------ ---------------------------- ----------------------------------- -------------.----t - =----------------•------------- ----------------------------------------------------------- --------------------------------------------------------------------- FINAL INSPECTION BY:----- tf- Date-------- �� �---- ----- ------- - + SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street ]24 Sycamore Street 205 West 9th Street ! Stockton,California Lodi,California Manteca,California Tracy,California i � Es 9 REVISED B-59 3M 3-'63 F.P.EO.