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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .-f_�.t...... _ ------ -- -------------------------------------------- + ------- --------------------- ----------------------------- (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 o construct-and install the work herein described. This application is made in compliance with County Ordinance No. 549. :+ _,[Gt�L c JOB ADDRESS AND LOCATION. Pit -- - - ---- Owner's Name ---- ----- Phone-•---•---------------------•-'-.t------!-- �Address------------ •--....---------------_----------- -------------------------_ Contractor's .Name----- ::.... '•._------ ------•---------------------------------------------------- --------------------------•--- Phone----•----------------_---------- Installation Residence Apartment House Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: � p ❑ ❑ Number of living units: _ _____ Number of bedrooms ___ Number of baths Lot size .. fir_-f.__.____:_--___. : ' -------- Water Supply: Publics stem ❑ CommunifiY system Private Depth to Water TableC�rft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam4 Clay Loam p Clay ❑ Adobe❑ Hardpan ❑ Previous PP Y INDNo ❑ F1No4, TYPE OF INSTALLATION.A 'SPI=CIFICAThONS: � New Construction:�Yes� No - FHA/VA: Yes (No-septic tank or cesspool permitted if,public sewer is available within 200 feet.) Sep.i Tank: Distance from nearest well____- __-_Distan,ce��f/rom{ foundation__-0___._____.Matersah.__ _��7 ____f'_ No. of compartments______�_ . __�!_Q_ _ ___Liquid depth__._____" Capacity_ _%' -____� ' t Disposal Field: Distance from near 'st well ___..._Distance from foundation.,-.-/ ____.Distance to nearest lot�Ilie_:_______________Number of lines____ ___ __._-_ __Length of each line !__ _. 1_-_l idth of trench___x:__.` _ s , -- �y Type of filter material____._____ Depth of filter material-----1�_ _........Total length_.__. __' _ET____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundatison___....-------------Distance to nearest lot line_________________ ❑ Number of pits---------------------Lining material'____------------------Size: Diameter-----------------------Depth-...----------------------------- Cesspool: Distance from nearest well-----_........___Distance from foundation._"*-------------Lining material__._..._______________.___________ ❑ Size: Diameter----------------------- ------•--- Depth--------------------------------------------------Liquid Capacity=----- ---------- gals. Privy: Distance from nearest well- ---------- ---------- ___._ -:_ is ante from nearest building----------- _ _______________ _________ } ❑ Distance to nearest lot line-------------------- ---------` "----------------------•---------------- -----------=--------------------------------------- Remodeling and/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. I(Si - - --------------------------------=---------------{Owner and/or Contractor gned)--/--•---------- --------------- / Y - BY:--- ------------------------------------------------------•--- --------------- - - ------------ ------------------ {Title) . --------------------- -------- ------ -- --- (Plot plan, showing size of lot, location of system Jn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------------------------------- ----------------- ------------------------- DATE------------------------------------------------------ REVIEWEDBY----------- ------------------------ ---------------- ---------- - - r !r-_�1 DATE----" s BUILDING PERMIT ISSUED-------------------------------------------------------------- -------------- DATE S ----------------- '`�-------------------- Alterationsand/or recommendations------- ---------------•-•----------------------------------••------------------ -----------------••---------•-------------------------------------------------- ------------------------------------•---------------------•---- ------------------------------------------ --------- ----------•------------------------------ --------------------------- --------- ------------------------------- - ....-------- -------- ------r -------- -----------•-------------------------------------•----------------•----------------------- ------------------------------- ------------- -------------------------•---- ------- -------- - --- FINAL INSPECTION BY---------- --- ------� ------- Date-- ---- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-54 ;3!A 3-'63 F.P.CD.