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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Y S" 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 hereindescribed. This application is made in compliant with County Ordinance No. 549. � Q ;J./_11 JOB ADDRESS AND LOCATI N. . . = ----------------------•-•--------- Owner's Name--- -----------1- -------- - ------------------------------------ Phone--------- --•----•---------•-------- ---------------- Contractor's Name-------- -- ------------- -- ---- Phone = Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.______ Number of bedrooms _�f 1 Number o aths ____L__ of size 3 Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA-.'Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / ° Septic nk: Distance from nearest well___-5,P------Distance from foundation______ _e-_____-.Matgril___A.U ............... No. of compartments..... Size�x �/ ..S�i uid de th_____ ______ _ ____ _ Ca acit ._..8 P__ Disp Field: Distance from nearest welll....Jr ----Distance from foundation _-ha--_._-___.Distance to nearest lot lined__----_---- ! Num er of of Typebof filternmaterial____. _ ._._____Depthhofffiltehmlaterial_ _ 1��Jotalhlength nch- ---------------------- Type -------------- t Seepage Pit: Distance to nearest well---------------------- 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---------------------------------- ❑ I Size: Diameter--------------------------------------Depth----•-- - - ----------------------------------------Liquid Capacity- --------------------------gals- Privy: Distance from nearest well------------_-------------------------------------Distance from nearest building-----------.--._________________._.1,------ . ❑ Distance to nearest lot line------------------------------------------------- -tj Remodeling and/or repairing (describe):------ ---------- ------------------------------------------------------•-•--------- ----- ------------•-----•-- --•-----------------------•---------------------•--------------------------------------------------------------------------------- -- --------------------•---------------- -------- 1 ------------------------------------ :------------------------ --------•-----------------------------_-___----------------------------------•-----------.-------------------------------------------------------a --------------------------------------------------------------------------------------------------------------------------------------------------••----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co nay j ; ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- -- --------------------------------------------------------------_„VDt=Srand/or Contractor). a BY=----------- - ----- ----------- -`------ - - ------ - --- -----------------------i-:--.-.----'------_m._ .=(Title)---------------------------------------------------------------- a ---- - --...------------ (Plot plan, showing size of lot, location of system.in rela i` on to wells;buildings, etc.,'can be placed on reverse side). FOR DEPARTMENt,USE ONLY , APPLICATION ACCEPTED BY_. . -------------------------- ---------------------------- REVIEWEDBY-------------------------------- --- -------- ---=_ —.._=LL -------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- -----------------------LL ------ ----~LL- DATE- Alterationsand/or recommendations:---------- -------------------------------------------- -----------------------------------------------•-•------------•-------------------------•-•----------- ----------------------------------------------------•----------------- ------ ------------- -------------- ----------------------------------------------------------------------------------------------------------------- --•-------------------------------------- -------•-•--------- --------------------------------------------•--------------------------------------- --- ' � Date ".3d' � FINAL INSPECTION BY:__ _ =_____ }.� ---------------------------------------------------------- SAN --------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3-'63 F.P.CD.