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OR FFICE USE: ------------------ ------------------------------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. ___-. �2j Z— ---------------- ---------- --------------------------- (Complete in Duplicate) -3/6 6- C�f: This Permit Expires 1 Year From Date Issued Date Issued __ ___rr.__:__- ® �-- D 4z-ag' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.. F . -This application is made in compliance with County Ordinance No. 549. -2--6AD-7 Al ,10044 A-V 6_k ,t JOB ADDRESS AND OC TIO l I ...... Owner's Name------ --- ! --------------------------------------- ----= Phone_.. ----------- -------•--- Address �t. .- ------ . .. ---------------•----••---------- ------------•------•-----f----- ---------- ------•-. - -Contractor's NamePhone ` __ �� .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ;Motel ❑ Other ❑ Number of living units: 3-_- Number of bedrooms -9--- Number of baths 3__ Lot size ----—7_4044-4004--0.1-------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand E] Gravel [:] San;dy Loam ❑ Clay Loam 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.) 4*�—Tank: Distance from nearest well-----------------Distance from foundation--------------___.Material _--_---__--------------------------------------- No. of compartments--------------------------Size-----•----------------------•---Liquid depth--------------------------Capacity------ -- ------------ e id: -----------eld: Distance from nearest well-.____._.Distance from foundation..3_Q-_------Distance to nearest lot Number of lines--------J---._.___ --------Length of each _-___.__-.Width of french--_...�--_ -- 0 Type of filter materials_- _L?C1 ___Depth of filter material___ _-_-Total length----(_. '_7---------- 44-,_....... e ePit: Distance to nearest well----------------------Distance from foundation------------- .___.Distance to nearest lot line---------_------ . Number of pits----------------------Lining material------------- _,-----Size: Diameter------.----------------Depth-�------------------.----------- � r Cesspoo Distance from nearest well-----------------Distance from foundation-------------I----.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth-------------------------------------------- I----Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well-------------------•.___--__---_'.____--_-_.--.-Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line-----------------------------------------------------------------....- ------------ , Remodeling and/or repairing (describe):-- ----------------------------------------------=-------------•------------------- --- .d. = t- . • -------------------------------------------------------------------------------------------------------------=--`--------•------------------------------ ----------•---------------------------------------•---------- --- -------------- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------"--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, ap laws, and-rules and regulations of the San Joaquin Local Health District. f (Signed)------ -- ------ ...___ __ ___- _ - wrier and/or Contractor) 6 T - -- ------ ------ ------- O-------- i------------------------ (Plot plan, showing size of lot, location of system in relation to wells, bu' ,ngs, etc., can be placed on reverse side), f FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY-------� -- 1,= ----------- -------------------- DATE----- = �y REVIEWEDBY-------------=-------------------------------------- - = ----------------------------------- DATE--------------------------- ----•- BUILDINGPERMIT .ISSUED------------------------------ --- ---------------------------—------------------------------------._ DATE-----------------------------�-------------- Alterations and/or recommendations:-----_---_-. -•-• ---------------------- ----- ------------------------------------ --------------------------------------------------------------------------------------------•-----------------•----•------------------------------- ------------ ------- --•------------------------------------------------------------•-----•------------------------------------------------------- ------ 1 --------------------------------------------------------- ............ ------------ ------------•------------------------------------------------------------- ----------------------------------------------------I I FINAL INSPECTION BY:- --- -`" -F �-------- - ---- Lr--- Date-----------------�- - - �/.--------------------- --------•----} S JOAQUIN LOCAL HEALTH DISTRICT F 1601 E.Hazelton Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 5-59 3M 3-•63 F.P.DD.