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FOR OFFICE USE: - Permit No. _-•• -_----- r �� APPLICATION FOR SANITATION PERMIT ' '- (Complete in Duplicate)"} Date Issued -------------- ---- ( - '_- --- _- ._-__.__- This permit Expires 1 Year_Fro_m 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. t ------------------- -------------------------------------------- I -JOB ADDRESS AND LOCATION-/--�------��s ---�-�----- -.-- -- -----------•----•----- Owner's Name---------- C.. ----- Phone-----•----------------•------------- Add ress-------------------- lae--- `F i l ��rl- - ��_ ----- 1 .--------- ----- Phone..�.�a-., Contractor's Name_"___.------I- Installation will serve: Residence [_<Partment House ElCommercial E] Trailer Court LlMotel 0Other ❑ Number of living units: - �__ Number of bedrooms --Number of baths -]_---- Lot size ____p. .-, ..--f�� - ------ Water Supply: Public system -_ om muriity system ❑ Private ❑ Depth to Water Table 460 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3--Hardpan ❑ Previous Application Made: (If yes,dcite--------------------) .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 240 feet.) : _-- --Y--s f $e �istance from nearest well-----------------Distance from foundation: --------------.. _- - --------------------- No. of comii f artments------------- ------------Size--------------------------------Liquid dep�h----------- .--------Ca pacitY Distance to nearest lot line,.,:�- D' s Distance from nearest well- {fT1R.!_.Distance from`.foundation_- -- ----__. __- _.. Number of lines------- -- __-_._ --Length of each line_-- :.�--.._----_-_Width of trench- - �f.. Type of filter material._ _ --.-t'------- __:Depth of flter mater-al-___- �_---,-__-Total I t'h -------- --- - ----------- e , See -`-- Pit: ace to n t well- tante om o tion _.Di nc to re I Numb pits---- - Lining mat "----'-Si is er--- --- Depth--- ----- --- ---------- - s gmaterial-1 , Cesspool: Distance from nearest well----_---_-_._-_-Distance'from..oundation--- ------------ - Lining material-1-.-_____-,_.-___----__--_-._'---_ Liqu tyl ❑ � Size: Diameter------------=- - - --- -te _�pth� ------------ Distance from neare'st±bui dana.�l".,"�------------------------ 0 z. ------ -- Privy: Distance from nearest well-=-------------------- ----------- 5 V1 ❑ �. Distance to nearest.lot line- ----- - ----a ----------- --------- ------------- ----------------------------------------------------------- )- ----- .: ---------------- - Remodeling and/or repairing (describe --- -- �- ---' -�-- - --------------- ---------------------•- -----------E----�--- ---------------•-------------------------------" .v --------------------------------- •-------------- -- - ---------- ----------- ------------ ----- I •------- -- --------------------------------- % )5 ---------------------------------------------------------- ,. --------- - --------------- ------------------____-_.-___-__-_----_-_--_--____------_-_---_.___----____,___-_______----_---_______----_____----_--_-__.----_-__--_ i 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 +he San Joaquin Local Health District. ie f Contractor (Signed) - s----------------------------------------- --(� } ------ ------- ----- (Title)-- ------------------------ ---- ------- --- --- BY:------------- i (Plot plan, showing size of lot, location of system in relation t wells,.buildings, etc., can be placed on reverse side}. ' ' t FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ ----- ..-c- .e'�------ f---------------------------------------- DATE rr i. -------------- REVIEWEDBY--------------------------------------------- --------------------------------------.,------------------------- DATE = ------ j BUILDING PERMIT ISSUED--------------------------- ----------------- - DATE---- --------- -- , ------------------------- - Alterations� re co mendations: --- = `gs`� " ` Sl ------------------ ---f ._�--�--------- r' - ' t ------------------------------------- --I----------------- ------- ----------- �s ---------------------- ---------------- -�'�`---- ---------------------------------------------------------••---------------------------------- ---------- ------------------------------------------------------------ 3 i ------------ --------------------- - -------------------------------------------------------------- FINAL INSPECTION BY:..------ 1 -C�'-._ t Date.... ---------- ------------------------------------------------- - =�.t SAN 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 E5 9 nEVISED 6-59 3M 3-'63 F.P.CD.