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FOR OFFICE USE: ----------------------------- ---------------- _--__.-.-___-------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../d'd l V -------------------------------------------------------- (Complete in Duplicate) _-_.--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with�n�Ordi nce No. X549. JOB ADDRESS A LOCATION. � __'7Ylsi___ Q __ __ _____ __ _ _ __ __ -___ act -- - - - - ---------------------------------- Owner's Name----- - ------- ------ Phone------------------------------------ ------- ---------------------------------------------------------- Contractor's ----------•-------------------••----- Address s I ---- ---• F 4 Contractor's Name -- ----------- --- Phone----------------------------------- Installation Installation will serve- Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other (] Number of living units: --/--- Number of bedrooms __Number `F baths .-__-/ Lot size ______ ___ ________._____ Water Supply: Public system E] Community system E) Private Depth to Water Table ___.___ ft _ �.. , Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam El .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 Tank: Distance from nearest well_________________Distance from foundation-------------------.Material---------------.---------------------.------------ F-1 ._____ .,.❑ No. of compartments--------------------------Size-------•--------------------:---Liquid depth--------------------------Capacity----------------------- Q Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot'line-____-__._.,_,_ ❑ Number of lines-----------------------------------Length of each line-----------------_-----------.Width of french------------- ------ Type of filter material-------------------------Depth of filter material-----------------------Total length---------- ---.---------------------`---- ` Seepa Pit: Distance to nearest well___-�P0-�_-_Distance fro ndation-..- 9___�__.Distance to nearest lot line__-_�_____ Number of its----- --- ----------Linin material_ - ..��Depth 3S' ' P � 9 � Size: Diameter p -------------------- Cesspool: Distance from nearest well_________________Distance from foundation_------------------Lining material------------__.-_-_-_____._____-_____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------ ------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------ ---------------------------- ❑ Distance to nearest lot line------------------------------- --------------------------------•-----------------------------------------------1---------------------------- Remodeling -----•-------- ---------Remodeling and/or repairing (describe)--- ---- ---------- -----•--T---------------------------------------------------------------•-------------------------------------------------------- ---- { - --------- ---------------------------------------------------- - ----T------------------------ 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 egulations of the S quip Local Health District. (Signed) Owner an r Contractor By:------------------- ---- --- - ------ -------ot------------ ----- --- - (Title) ...... (Plot plan, shgwing siz ; location of system in relation to ells, building etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ION ACCEPTED BY---.._ _ DATE--1.O1__`__/------ - ------ --------------------------- APPLIC REVIEWED BY-------------------------------- ----------------- ------- ---------------------------- ._. --------------- -•- DATE------ -----------------------F - - - -- ----------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------- ----------------- DATE--------------------------------- and/or recommendations:---------------------------------------------- --------•-----------------------------------------------------•-------------------'---------------------------- ------------------------------------------------------------------ { ----------------- - ---------------------------- ---------- -----------------------------------------------------------------•---•-•------------------------------------------------------------------------ ------------- -------------- ------ ------ -------------------- --------- ------------- -------------------- -------------------------------------------------------------------- ------------------------ ----------------- FINAL INSPECTION BY:. ? -------------------- Date-- ---- - ----------Y------------------------------ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REWSED 8.59 314 3-'63 F.P.CO.