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FOR OFFICE USE: ---------------------------------------------- ---------- ----------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----_------ ,------------------------------------- (Complete in Duplicate) -------.--- This Permit Expires 1 Year From Date Issued Date Issued-7_ D �6 Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. Q(3_ Leo —S 0, JOB ADDRESS AND L CATION_ /� -------------- i ----------------------- Owner's Name-------•-- -- -- - .-- •----------•- ------ ------•------ - --------- Phone Address--------------- ---- ------------"• _ - = = - ------------------------------ -- -- Contractors Name--- .._... y Phone------- '------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 'Number of living units: __'___ Number of bedrooms ________ Number f baths Lot size _____1_i_d Water Supply: Public system E] Community system ❑ Private Depth Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________l 'No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' L11 _ (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) _ . .., . ance from Septi ank: Not of tom artmEntsi well_ _-�---Distance f, m fo n Ian__./� ____-- ----'__ �'--- ---_---- p � 7X liquid depth ---- ----- ---- -Ca acct � . : p Y s Disposa Meld: Distance from nearest well---.90- Distance from foundation---�__ _._-_.Distance to nearest lot Number of lines.________._. _ Len th of each line_____�Q____-_ ____ ` g #._.Width of trench...e__`_�' __:_____-_. ______Depth of filter material-___-�_____-_,,Total length_- ;.9 Q__=`_____________________ Type.of,filter material_ ___- I Seepage Pit; Distance to nearest well-------______________Distance from foundation-------------------.Distance to nearest lot line____ _______ ,� ❑ Number of pits__k ...__:___Lining material-_________.=______.___Size: Diameter_.---____._;__..__ f } Depth - ----- ob Cesspool: Distance.from nearest well_________________Distance from foundation_________-------__.Lining materialf-_-._______ --------------------- ❑ Size: Diameter--- ---------------------- --- ------De th-----=----------------------- --- ---- ------- --Liquid Ca aci' _�-_-_---^----ty------------:- '-ga Privy-. Distance from nearest well________________________________________________Distance from nearest building------------------- ❑ ..l .s_.. ; Distanceto nearest lot line------ ----------------------------------.------------------------------------------------------------------------------------ Remodeling and/or repairing {describe)----- --------------------------------------=------------••--------------•--•--------•-----------•-------•---------- ----- ---- -------------------------------------- _------------------------ --------------- ---------- -___----------------------------- _------------------------------------------------------------------------------- fie- ^- _____________________--------_____________~____________________---_________.______________________-_________--__.__-___________________________________________.___..._ _ / I ; 4 (TL ________________________________________________________________________________________________________________________________________________________________________________________________________________________..____ 0 6 I hereby certify that I have prepahed this application and that the work will be done in accordance with San Joaquin County s" ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. { (Signed) = ---------------------------------------------------------------------- /or Contractor) f ' By: ---- --- -- - --------- - - ------(Title)..---------------- --------------------- (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be•placed on reverse.side). FOR DEPARTMENT USE ONLY G 4 O APPLICATION ACCEPTEDBY _G �► ---------------------- DATE S REVIEWEDBY---- _------------------------------------- -----------------.-.----------------------------------------------------------- DATE------------------------- 'S BUILDING PERMIT ISSUED ------------ ----------------------------------- DATE--- Alterations and/or recommendations:------ -•----------------------------- -- --- ----------------•-----------------------------------------•------------ ------------------------- - ----------------------•----•--•--------------------•------------------------------- I E e `_______________-.___._.__----------------------------------------------.___----.---------------------------------------------._-------------------------------------------------___________.._.___-_-_____...____.__.___.____ FINAL INSPECTION BY:� - �_r�� Date r � �� ------------------- -------------------------------- SAN --------------------- -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 ES 9 REVISED 8-59 `.SIA 3-'63 F.P.120.