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FO OFFICE USE: -- - APPLICATION FOR SANITATION PERMIT Permit No. ........ .. (Complete in Duplicate) -- 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 Ordipjrice No. 549. Cs JOB ADDRESS AN CA ON------- �- -- --------� ----- --------•------- ----- Owner's Name------ --- -- -- ---- ----- ----- - ------------------------ -•------•--- --- ------ Phone----•------------------------------- Address----------•--------------- ----------------------•-------- Phone----••--_•------•------------------ Contractor's Name-----------------•-•-•----- ------------------------------------------- •-------- Installation will serve: :ResidenceA artment House Commercial E] Trailer Court ElMotel ❑ Other El � �__._ Number of bedrooms __-/__ Number of baths __f____ Lot size __�QX-/47 Number of living units: _ - "�� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6--d- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] Previous Application Made: (if yes,date.-------_..........1 No ❑ New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) l7 pistance from foundation___ //Q_____-__.Mat rial___ _______________________ _ Septic Tank: Distance from nearest well-)I -__._____ d-- - _ p - --------- ----- No. of compartments- a ------------------Size_ 5}<----------Liquid depth----- ----- ----------Capacity- Dis Dial Field: Distance from neares weiZ. --'Distance from foundation.- - ---- ---Distance to nearest lot line y___-__.__J.. x Number of lines______ ----------------- .-Length of each line---o�----------;-------Width of trench-------- �-------------�---- ----- Type of filter materialg-/_ p .--Depth of filter material_____�I--------.Total length____________________________)------- rn Seepage Pit: Distance to nearest well-----___________-____Distance from foundation__________________Distance to nearest lot line-______-_____--_ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------ - Cesspool: Distance from nearest well__-__-______---i_Distance from foundation--------------------Lining material-----------------.------------------- . El Size: Diameter Depth----------------------------- -------- -------------Liquid Capacity----------------------- -gals. Privy: Distance from nearest well------------------------- ------------.----------Distance from nearest building-----------______-________-__---_-- ❑ Distance to nearest lot line----------------------------- ----------- -------------------------------------------------- ------------- Remodeling and/or repairing (describe)=--------------------------------- --------------------------------------- --------------------- ------------------------ - - -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby ertify hat I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State la , and rules and regulations of the San Joaquin Local Health District. Signtad� __'O r Contractor) Der and o or - - ---------- { s---------- Title (Plot plan, showing size of lot, location of system in relation to wells, buil ' gs, etc., can be placed on 7reverse side). FOR DEPARTMENT ... E ONLY APPLICATIONACCEPTED BY-----C_x ------------------------------------------------------------------------- DATE-- 1 Q=' _--_(a. ---------------------------- REVIEWEDBY-------------------------------------------------------------------- DATE--------------------------------------------- -------------- BUILDINGPERMIT ISSUED------------------ --------- ------------------------------------- DATE----------------- ----------------------------- -------------- Alterations and/or recommendations:----------------- ------ -------------------------------------••---------------------------- ------------------------------------- --------------------------- ---•--------------------------"--•--------------- y { E I • ter,.... - �. . e� �,, � ... .. Date �� 4-- ---(0-'2,z>- - -------- --- ------------------------- FINAL INSPECTION BY:_--_Q__- ---------- c.x5z�------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-59 3M 3-'63 F.P.CC.