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FOR OFFICE USE: - ------------------:------------------------------------- ` ____________________.____-___.._..____.._____---- APPLICATION FOR SANITATION PERMIT Permit No. ../. .1 . -------------- --- -------------------------- (Complete in Duplicate) 6 / Date issued -------------------------- -------- -------------------- This Permit Ex ires'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 Ord.ihance No. 549. 21 JOB ADDRESS ANV OC CATI _______ _ _'-_-�A�-A-,_---_T- -�-- ---,- ��_ - ----------- -4- Owner's Name -- ----•----- ------- Phone_'__ ------f--�------------------�-- Address-----•--------- tP f t - •------•---------------•--•---'---- Contractor's Name------------ -----+^ct- _... r Phone.. ,) V Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other Number of living units: ___ -. Number of bedrooms:_umber f baths -- �-_ Lot size ____ .___-_' ____ _ ___ _____________________-_____ Water Supply: Public system E) Commun'ity system El . Private Depth to Water Table _ ft. Character of soil to a depth of 3 feet:_*-Sand ❑ Gravel ❑` .'Sandy Loam [:] Clay Loam [Clay ❑ Adobe El Hardpan F-1,Previous Application Made: ,(If-yes,dcste:":_:.j-.f_i..__.__-) No ❑ New Construction: Yes ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) Septic ank: Distance from nearest well_.____��'_-Distance from foundattion__-. 0__�__-_-M teriaL__ ^- -----_--_. No. of compartments---------�--_--Size--- '�----�_F __Liquid depth---� /-------- -_Capacity-- �- -- Dispos field: Distance from nearest well,'_�-�___1_____._Distance from foundation----/a_...........Distance to nearest lot line_-._- Nurnber of lines---- !_.-----------------------Length of each line-- -------...Width.of trench---- --r__-______- �� Type of filter mafierial_ 11 °z�1r Depth of filter material__--f7-____-.___.Total length.__._!.O__U______________- ________ 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________________Distance from foundation._._._._________..Lining material---------------- _..________,-_______. ❑ m Sze: Diaeter-- ' -------- -----------m------.Depth---'----------------- ---------------------------Liquid Capacity----------------------- -gdls.* Privy. Distance from nearest well::-_' ------------------------- _--------_________Distance from nearest building____._______ ___.___________-___.__.__- ❑ Distance-to nearest lot line- - - ------- ----- ------_---------------`-•---_ --------------- -------=--------------- - --------------------------------------•--- rRemodeling and/or repairing (descbe): - -- - ----------•----------------------•--- - i ---------------------------------------------- ---------------------------•---------------------•----^- - .� I - ------------------------- --------------•--------------- I hereby ce ' y that I have epared this application and that the work will be done in accordance with San Joaquin County�" ordinances, Sat I ws, and rules nd re ation f the San Joaquin Local Health District, i (Si ned 9 )------ ---- - •---- ---�- ----•---- � -r----- -- -- - - - --- ----- - ----------------- --------------------•-------------------- d/or Contractor)., .. By: (Title) (Plot plan, showing.size of lot, location of system in relation o wells, buil ings, etc., can be placed on reverse side). �'} d j• x a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------------- DATE------ __ '6 REVIEWED BY---------------------------------------'-- •------------------•--------- DATE BUILDING PERMIT ISSUED----=----- ---- - ------------- DATE------------------------- } Alterations and/or recommendations:--___ _________________---_ -------------------------------------------------------- -----------------------------------• _•-.. -------------------------------------------_------------------------••------------------------------------------- I --------------------------------------------- .------- -•------------------.-•.-------------------------------------------------------------------- ---------------------- -------------------------------------- i ---•----------------------•---_.---- -------------------------------- ----------- ----------------------------- -- ---------------------------------- ------------ .- FINAL INSPECTION BY:..�` ` .. Q tea _- Date _._-_G.-__� `'7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.F.CD.