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FOR OFFICE USE: ------------------------------------- --------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No- - --- --------------- 7 ------------------- ------- ------.-:.,- ------ (Complete in Duplicate) i 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 herein described. This application is made in compliance with County Ordinance No. 549. ` JOB ADDRESS AND LOCATION..__• __ ------------- Owner's Name -5`s' ==� '`�''"x--C~ Ads- -------------=--- ------------- ----- Phone = �'- ^ ; ------------------------------------ Address------------ 1I P '`:,•�' r� ------- k1 ►�!' _A-S'` ►1= s_f ,----------------------------------- Contractor's Name .1_ -!e-`"'x t ------------------------------------------------------- Phone------------ ---------------- Installation will serve: Residence [5 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1:__ Number of bedrooms --?___ Number of baths _: __ Lot size --------- ___ _ Wa+er Supply: Public system ❑ Community system [M Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam R1 Clay ❑ Adobe ❑ .. Hardpan ❑ Previous Application Made: (If yes,Bate--------------------) No ❑ New Construction: Yes X1 No ❑ PHA/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-_'4600-__Distance from foundation-_____ _A:_ .....Material------------------------------------------------ _ No. of compartments------------ --------Size-----�X--f---------------Liquid depth---------�/ ----------Capacity-----/"_ -43'0---- Ir A Disposal Field: Distance from nearest welL_.3,5_0_.Distance from foundation-__2�?_._____._.Distance to nearest lot line____: ❑ Number of lines____-.____-__±0'-----------------Length of eache-Width of trench------- ---------------------- Type of filter material.__f t2_ erg-VDepth.of filter material------- _¢-__.Total length------------ _________________ a. \ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El ___________._❑ Number of pits---------- ---------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- Cesspool: Distance from nearest well---------_-------Distance from foundation___.------ ___-___..Lining material-------------------------------------- ❑._ Size: , Diameter----- ----- r----- -----Depth-----------------------------------------------------Liquid Capacity-- ------ -----------gals. Privy: _ Distance from nearest Weil ___ --------------------- ----- __-_._Distance from nearest-building__----------------------------------- ] Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------•-•--••-----------------------------------------------------------•----------- ----------------•---•--------------------------------------------------------------------------:---------------------------------------------------------------- ------------------------------------- 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 regulations of the San Joaquin, Local Health District. Si ned - __` _5 'k' 1 './. - ------ � c s:� -----------------=-------=-------------------------- ---- -------------(Owner and/or Contractork ( g i By:--------------- ------------------ ---------------------------------------------(Title)-------------------------------- ------ --- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -- - - ---'--- ------------------------------------------------------------------ DATE------- 6------------ BY-------------------------- ---- ----------- ----------------- ------------ --------------------•-------------------- DATE----------------------------------- BUILDINGPERMIT ISSUED--•------------------------------------ -------------------------------------------------------------- DATE- Alterationsand/or recommendations:----- - -----------------------------------------------------------------------------L----------------------- -----------------------------------------.. ------------------------------ ------------------------------------------------------------------------------------------------------------------•-----------------------•--------------------------------------- ---------------------------------------- --- -•--------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------- t --- --------------- --------------- -------------------------- G t FINAL INSPECTIO Y:-- ----T - - --- - - ------ ---- - - Date------------�-��- r-o�-"7�- ��'- '�'- - ------------------------------------ AN 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 99 9 REVISED B-5$ 3M 3-'63 F.P.CC.