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FOR OFFICE USE: 7 �---------------_-_-� -.-.- APPLICATION FOR SANITATION PERMIT Permit No. __- ?�-f J-_----- L - 'f____- ._____--.__ n ----- (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. This application is made in compliance with County Ordinance No. 549. , JOBADDRESS AND LOCATION ------------------------------ ------- ----------------- ---•------------------------------------ ;Owner's Name------- �" - �/�' -------------------- Phone- - �/�_' ----------�- -• -- } Address-------------------------•--� (2-�----C._-'f4--e-(/_ ----------------------------• --•------------------------------------=---------------------------- Contractor's Name ----------------------- o ----- Phone Installation will serve: Residence Apartment House [Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: _ __ umber of bedrooms _;:�_ Number of baths.___ Lot size _-_-_G_4___--- „5-_---_6_�a Water Supply: Public system [Community system ❑ Private'❑ Depth to Water Table `S__ ft. Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0j,--<ardpan ❑ Previous Application Made: (If yes,date--------------------) No CO/ New Construction: Yes Eg-`I�o ❑ 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------------------------------------------------- 171 No. of compartments------- ------------------Size---------------------------- ---Liquid depth--------------------------Capacity----------------------- 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---------------------__-__-__-____f____ N Seepage Pit: Distance to nearest well.7s' �ADistance from foundation-----A! .Distance to nearest lot pline__-__,-�_? ®__ Number of pits------,#/----------Lining material-----------------------Size: Dia'R5Mr--------K*_&-Dept h-------1f_____________-________ 4 t Cesspool: Distance from nearestiwell-----------------Distance from foundation--------------------Lining material------------------------------------- n1 171Size: Diameter- -----If------------------------------Depth---------------------------_---------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________--_---_-_______-____-.____. ❑ Distance to nearest lot line----- --------------- ----------- ------------------------------------------------- ----------------------------------------------------- Remodeling and/or repairing (describe):--- P l - --- e-- - ` - --,�z ------------- --------r------7!�. ------------------••----------------------------•-------------•------- --------------------------------•-----------------------•-• -------•--------------------------------------•------------- ----------- - - 1 i ---------------------------------------------------------------------------------------------------------------------------------------------•--•-----------------------------•-----------....--- ----------------- --tom r—_ '` -------- ----------------------------------------------•--•--------------: --------------------•--------------•-------------------------------------------------------------------------•----- ---- --------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San 'Joaquin County 3 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) . ----(Owner and/or Contractor) By:-------------------------------------------------------.----------------------------------------------------------------------------(Title)---------------------------- --------------- -- ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY cod DATE7- 'I - ----- -------------------- REVIEWEDBY------------------------------------------------------ ---------------------------------------- DATE----------------------------------------- ------------------ BUILDING ----------------- BUILDINGPERMIT ISSUED-------------- ------------------------------------------- --------------= DATE--------------------------------------- Alterations an or recommen ations'-- ------- --------------------- ------------------------------------------- -------------- ------------------- ---------------•-•- ° l L -t" __ ---------•-------- -------------------•------------------------------•------------------------------------------------ -----------------------------------------------•-----------•-- ----------------- ---------------------- --- -----------------------------------------------------------------------------------------------•------------------------------•-- ------------- ------------------------------ . _ - --------------------------- FINAL INSPECTION BY:--------- --`- c�`�- ------------------ 4 Date �'/ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=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-59 3M 3-'63 F.P.CO. y