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FOR OFFI E USE: APPLICATION FOR SANITATION PERMIT Permit No. _. ................ - --------- ------- -------- - (Complete in Duplicate) Date 1'ssued -- Expires _ � 1.... - - - - _____________________ This Permit 1 Year From Date Issued - tl - - 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 Ordi ante 49. JOB ADDRESS AND O TION �� -------------------------------------------•--------....... Owner's Name-------- ----------------------------------------- Phone 17` Address ---------- ---------------------------•------......-- .................... - o Contractor's Name__ _ - ------- ' Installation will serve: Residence J/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _y Number of bedrooms __Number of baths --- Lot size ----/' - _`-->4_' -__I-_--_-__-__ t; Water Supply: Public system Community system [I Private E] Depth to Water Table _.6-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay El Adobe ❑ Previous Application Made: [If yes date___.- ) No ❑ New Construction: Yes ❑ No_FHA/VA: Yes El ❑ TYPE F INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) PD �� Distance from nearest well_________________Distance from foundation--------------------Material_--_____--______-_-________-_-______________._. No. of compartments--------------------------Size-----------•--------------------Liquid depth-------- ------------------Capacity----------------------- ^ rJ�b� Q� // / d: Distance from nearesj well- f.-.Distance from foundation---/_ _ ______Distance to nearest lot line._______�a____ Number of lines____-___!_____ _________________Length of each line..-._ _ -------.Width of trench---...._. -.��-`----.-...._ Type of filter material__ _ ...__Depth of filter material___,/x........Total length____ _`_________________________ age Rit: Distance to nearest'weli----ll_,,r_'Distance fw �ff,oupdation__..Z.0. ....Dist6nce to nearest lot line----------------- 66 Number of pits------- Linin material_ C�1�:.Size. Diameter.-_.3.3-1�____.Depth---------- -------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- CA [❑ Size: Diameter--------------------------------------Depth----•--------------------------------------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.-----------------'--------------------.----------Distance from nearest building--:_-___________________________.___. ❑ Distance to nearest lot lin"e -------- ------------------------------------------------------ ----------------------------------------------------• ------------ - Remodeling and/or repairing (describe): --------------------- ------------------------------------------------------------------------------- ------------- ---------------------- --- ------------------•-••-----------------------•---------------- ------------------------------------------ ------- ---------- ---•--------------•--• -•----------- ---------------------------------------------------------------------------•----------•--------------------- 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 regu tions of the Sa ui�Loll alth District. a (Signed)-- u-� ��{ l f Xes, ------------------- •--------------- -Contractor] 1 By-------------------------------------------------------------------------------------------- �f �7e ..__c_a_n,be - - -(Title)-------------------------- --- - (Plot plan, showing size of lot, location of system in relationuildings, -placed on reverse side). FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY-------------------------------------------------------- --•------------------------ DATE------------r--- -------- ---------------- REVIEWEDBY----------------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED,------------------------------------------------------------—--•----------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations::--l------------------ ....-� ........ ------------•- •----------------•--•----•--------_-.-_------•------- ---------------------------------------------------------------------------------------------------------------•-----------------------------------•-----------------------------------------•---------------------•••----- -----•------------------------------------------------------------------------------------------------------------------•---------•---------------•------------------------•--------------•-------------=------------.-•------ FINAL INSPECTION BY:---G-...... - -------------•-------------•-- Date.-J- 4" ---•._. . 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 E6.9 NEVIS Eo a-59 r.P.Ca.2m 6.60