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FOR- - F F�IC E USE: ------------ ----------/- ------------- - -- -------- V --- ---- ---- APPLICATION FPR SANITATION PERMIT Permit No. (Complete in Duplicate) ------ --- ---- -------------- This Permit Expires I Year From Date Issued Date Issued ------------ ---- Application is hereby made the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati.onis-made.in compliance with C unty Ordinance No. 549. E ,j-, 00 j_- — 3.yo - - ---------a JOB ADDRESS AND LOCATION._-- ------------ -------- ------- Phone. --- -------------------_--------- Owner's Name--• ......... ------------------------------------- 9 e ........ ........................................................ Address------------------ ........ �.......-0.-!!N�---470�-------------- ------------------------ Contractor's Name.. . .....z- ------- -------------••---------------•- ----------. Phone----------------------------------- Installation will serve: ResideAce pg Apartment House [3 Commercial [] Tr;'Iler Court [I Motel 0 Other 11 _----------------- Number of living units: ----- Number of bedrooms Number of baths A— Lot size ........ 0 Wa.for Supply: Public sysfern4�j jComtyiunifyrsystsm 0 PrivateR -Depth to Wafer Tabie-q.!P_ ft. Character of roil to a depth of 3 feet: Sa-n%'d E]- Gravel r] Sandy Loam [I Clay Loam Clay El Adobe 0 Hardpan Previous Application Made: (if yes date--------------------) No New Construction. Yes No [I FHA/VA.- Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is availablewithin 200 feet.) Septic Tank: Distance' from nearest -----Distance fro foundation-1 0------------Material-to---Ta-,-,c�itv.. ------ 1.4 -------------_- Size.*��t__f_4-----C,---Liquid depth---- 1%----------------capacity.... .. No. of compartments-------- ............. i 11 Distance from nearest Disposal Field: well "Distance from foundation.__...._----------Distance to nearest lot line_& ............. -------- Length of each'line-=.--k.)--Q-.............Width of trench...1:0.0..................... Number of lines....-__f-.. LA� 4 - !�� ....................... Te-1-Depth of-filter material_../_,j_!_.__--_-_.--Total length---- Type of filter m � we - . Ir, Seepage Pit: Distance to nearest we(./-rvl----------Distance from fpundation..../19...........Distance to nearest lot IjD ......... ----Size:!Diameter — Depth--- ----------------- Number of pits----I--------•------Lining material-4-W--- Cesspool: Distance from nearest well------------------Distance from foundation---:_-----_--_--- Lining material..----._-__-----__-..._.------_----_. ❑ ...gals. Size: Diameter----------- -----------------------_Depth------------------------h--------------------------Liquid Capacity------------------- Privy: Distance from nearest well------ ------------------------------------------Distance from nearest"building---------------•-------------------------- Distance to nearest ]of line----- -----------------------------------:----------------------------------------------------------------------------------------------- ❑ --------------------- Remodeling and/or repairing (describe):--------------- --------------------------------------------I—----------------------------I...................... -----_------------------_--------------------------------------------------------------•---------•------------------------------I_---------•------------------------------------------------------I---_---------------- -----------------------------------------------------------------I-------------------------------------I -------------------------------------------•-- ------------------""-"-•-----------I I--••-- I -----I----------------------------------------------------------------------------------------- ................... -------------------------------- ---------------------------------------------------- I hereby certify that I have prepared this application and thatthework will be clone in accordance with h San Joaquin County ordinances, State laws, and rules and regulations of the Sin Joaquin Local Health District. -----------------------------------------------------------------------(Owner and/or Contractor) (Sig7d ----------- ----- ------------------------------------------- ----------------------------(Title)--------------------------------I ------=-- -- -------------- By:--- ----------------•-------------------- (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 ------------- DATE-.-,f- ..zt-------------------------------- -------- APPLICATION ACCEPTED 0V".0#"_111!i1" ---- -- ---------•-------------------------------------------------- REVIEWEDBY------_--------------- ------------------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------ --- - -----------------------------------------------—-------------------------------------- DATE------------------------------ ------------------------------ Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- - J ........ -------1------------------- ----------------------------------------------------------------------------------•------------ -- ------------------ i�---------------------------------------- ........... ------------------------------------------3-----------i------------------------------------------------------------------ --------------------------------------------------------------------------------- 1k ---- ........................ ............. ................. -------------- ------------------------ ---------------------------------------------------------........................................ --------------- --------------------------------- ----------------------------I............ —--------------I--------------- ------------_------------------------------------------------------------- ------------------------I------- FINAL INSPECTION BY-.-...- ----------- -------------- Date---- -------- ...... ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-61 AILAB