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-I- -I I1 FOR OFFICE USE: 40 4!'-16C ------------------------ -------------------------------- APPLICATION FOR SANITATION PERMITPermit No. 2...... --------------------------------------------------------- ---------------------------- ---------------------------- (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 to construct and install the work herein described. This application is made in compliance with County-Ordinance No. 549. JOB ADDRESS AND LOCATION. ............. 66v-,4- ------y.....-- --------------------- ................................... .. ..... -------------------------------------------------------------------------- Phone---- Owner's Name------- __,e_.)-------1__ Address..........JA ....... ------------ .. .. . ............... --- ------ . .... ----------------------------------------------------------------------------- Contractor's Name---------------••Azdc/............................................................------------------------------------------------- Phone................................... Installation will serve: Residence 4 Apartment House E] Commercial E] Trailer Court 0 Motel 0 Other 0 Number of living units: I---- Number of bedrooms ---I--- Number of baths ___1--- Lot size ---------:57_,x*.IA�Q--------------------- Water Supply:, Public system F-1 Community system Private E] Depth to Water Table .-/-. ft. Character of soil to a depth of 3 feet: Sand F] Gravel F ] Sandy Loam n Clay Loam 171 ClayX Adobe F Hardpan El Previous Application Made: (if yes,date---------- ---------) No New Construction: Yes 0 No El F-HANA: Yes El No,E)e 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---------------------------------------------- No. of compartments--------------------------Size................................Liquid depth--------------------------Capacity...... ................ Disposal Fieldj Distance from neare)� welI___30e-_y.41 Distance from foundation......!;;�:.......Distance to nearest lot line_..4;.......ta Number of lines-----------------------------------Length of each ...Width of trench --------------------- Type of filter Depth of filter material--- ....Total length..........Y-4.)----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 1771 Number of pits______________________Lining material-----------------------Size: Diameter__-_-...____-_.-_...__-Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-.-----------------Lining material------------------------------ ------- 1771 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. abuilding._-- Privy: Distance from nearest well-_________ ------------ -Distance rom nearest -------------------------------------- 1771 Distance to nearest lot line---------- ----------------------------------------------------------------------------------------------------- ---------------------------- Remodeling and/or repairing (describe):__. _-- -------•---•-•-•--•--••----•--•. ------------------------- ------------------------------------------------------------------------------------ ------ -------------------------------------------------------------•-----------------------------------------------------------------------------------•------------•---------.--- -------------t-------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------........ ------------------------------ 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 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). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- ------------------------------------------------------------------------------------ DATE--------------------------------------------------- REVIEWED BY__....... --------------------------------------------------------------; --D-------- DATE- - ---- --- -- - ------------------- BUILDING PERMIT ISSUED --------- DATE--------- -- - ---j- ------ ------ Alterationsand/or recommendations:---------- ---------- ....................................................................................................................---------------- ---------------------------------------------------------------------- -----------------------------------------------------------------------------------------............................................................ ----------4-------------------------------------------------------------------------------------------------------------------------------------------- ---------- ----------------------------------------------------- ---------------------------------------------- ....... --------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------- ---------------------- ----------------------------------- /------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:. ---------- - - -- ----------------- -------------------- ------------- Date-------_-------- ------ ---------------- 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, 95 9 REVISED S-59 3M 3-'63 F.P.120.