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rvrc vrrlC,t Wk: .4 0 --` --------G�'-..-I- -C -- APPLICATION FOR SANITATION PERMIT Permit No. ;��-_l..S - ----------------------- --------------------- --------- (Complete in Duplicate) ---- ---- ------------------------__------ - Date Issued / � [./ - - - - This Permit Ex fires ] 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 Or finance No.)549. JOB ADDRESS AN CtA,T O Owner's Name-------""--- --•_""-- - -------------------------------------- Phone ------ ------- --•-------------- -- ---------------------------------•------------------------••----------------------------------------------•------•------•------••-•----•- Contractor's Name----- _-__ Installation will serve: Residence [Apartment House ❑ Commercial [3 Trailer Court ED Motel ❑ Other ❑ Number of living units: ___I__ Number of bedrooms _ Number of baths _�___- Lot size . Water Supply: Public system [—] Community system E] Private �epth to Water Table _____P ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [l—'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.) SepSe an Distance from nearest w 11 -f from foundati 4n-�----- --._ Materia--��-- � - f ompartments__Z 3 ' ---------- �----Size--------XJ•�`---�- _Liquid depth------�.--- ----- ,Capacity---��0� Disposal "- Distance from nearest well... Distance from foundation--------------------Distance to nearest lot line----_"_____-__--- ❑ Number of lines-----------------------------------Length of each line-----_-----------------------.Width of trench----------"""-- �f Type of filter material-------------------------Depth of filter material-----------------------Total length_"______-__________._____________-- Seepage Pit: Distance to nearest well---------------.------Distance from foundation--------------------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--.---------------------------------------------"Distance from nearest buildin ❑ Distance to nearest lot line _______ 9 O Remodeling and/or repairing (describe):-__ __-.__. _ > r_�___ - ......� ._ --------------------- �_ ---------------------------------------- 7 ----------------------------------------------------------------- -----------------•----------- ------ ----- - - - --• - - -- ----------- - - --- ----- ------ I certify that I have """""" Y y prepared this application an that a work will be done in accordance with San Joaquin County ordinances, State laws, ] and r gulations of +he S Joa n Local Health District. (Signed)-------• / --` ---- -----------(::::> (Owner and/or Contractor) BY� ............................. Title -----,.----- ---- -------- - - -------------------------------------------- P of plan, showing size of lot, location of system in relation to we Is, buildings, etc., can be placed on reverse side). rt FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By....... ---- _ DATE 4 4 ------------- REVIEWED BY----- ---------------- - ------ ----- ----- -------- -------- -------- DATE---•- ---------- -----•----------- BUILDING PERMIT ISSUED--------------- ------------------------- �,f - ----------------- DATE----------------------- -------------------------- ---- Al+erations and/or recommendations:"_ _--A4+_-A---..-.--_----).h-s ,., - "�f-"" "" - FINAL INSPECTION BY:----C..c. ------ ---------------------------- ADate .: ' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 f.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 31A 3•'53 F.P.CC.