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p/ FOR OFFICE USE: --- r � �- 36 --------------- --- ------------------------------------- APPLICATION' FORS SANITATION PERMIT �; ..a� Permit No. ...._ oo/ P ................... -(Complete in Duplicate) ------------- ------- ------ This Permit Expires 1 Year From Date Issued Date Issued -._ Application is hereby made to flie San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafion-is made in compliance with County Ordinanc No, 549. P JOB ADDRESS A CAT! N.._•� ---_ - i Owner's Name --- Phonel r" 'e? -... ------- ------- --------------•----------------------------- --------------------------------- --------------- Contractor's Name Phone__' e�� "e �y.?s ------------------------------- Installation will server `Residence Apartment House-E]--Commercia! ❑j Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _ -. Number of bedroo �-- -r.�. . Number of baths/Al,-Lot size -- --------------------------- Wafer Supply: Public system ❑ Community system Private [?]epth to Water Table ,_D ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam 0 Clay Loam ❑ Clay❑ Adobe [Y]'Hardpan ❑ I Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes [�No ❑ FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i - " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic-.'Tank: Distance from nearest wells. __--:---Distance from foundation-..,/Q---_----- Material. --- No. of compartments------aZ------------"-Size 3- l ---------..Liquid depth--- -- --------------Capacity.�l4d__ r 1.-m ..v*. Disposal •Field: Distance from nearest wellS_.© Distance from foundafiion...�.Q--"_..-.Distance to nearest lot line-..__._..4_... 1 l-7 Number of lines---------/---------- Len th of each lin-e -- -- ------.Width of french------- -- D ----- ---- Type of'Tilter material..-�.'.- _ i . Depth of filter.material_.../�'---- -__---Total lengfh�..._..•---------_----�d.....•"--_-- � Seepage Pit: Distance to nearest well______________________Distance from found afion...___._...._. ._...Distance to nearest lot line----------------- „r Number of pits------------------------------Lining material---------------------- Size: Diameter----------------------.Depth----------- --------Cesspool: Distance from nearest well-----------------Distance from foundation..- --------- ---- mater ial----- -----------❑ Size: Diameter. = Depth ------- -- ----------- --- -------Liquid Capacity----------------------------gals, --- Privy: Distance from nearest well------------------------ .-.___..Distance from nearesf buildingL ----------------- ❑ Distance to nearest. lot line----- - t r t ------------------------ Remodeling ._ -- ---------- - - ----�--_------ ------ Remodeling and/or repairing {describe:- "_" :. •----------------------- 1/ -----------•---- , ------------------------------------------ ---•---------------------------------------•----- : � -------------------------•"---------------------•---------------------------------------------- -------1 hereby certify that I have prepared%jhis application and that the work will be done in accordance with San Joaquin County Q.110 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' f (Signed) 1J --•--- --�----j-�----- :(Owner ran and/or Contractor) ----------------- By: "�� tiTite)- ----- -- -- - -�----------- --------------------------------- (Plot plan, showing size of lot, location of system in relation to wel buildings, efc., can.be placed oK reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE a ' I ' --------------------------------- REVIEWED BY -- i, := = --------- . DATE---- -- ------------------ = BUILDING PERMIT ISSUED.-------------- ,! --------------- --------------•--------------------- ------------ DATE----------------- f Aerations and/or recotrlmendations:.-.--- _- _ "'"""----- -------•---------------------- ------- --------- --------------_....__.------------------------------------ ------------------------------------------------------•. --------------------------------- FINAL INSPECTION BY:----- t..� : _ � ----- Date----- - � - V .t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. Street 124 Sycamore Street 205 West 9!h StreetStockton,California 300 West Oak Lodi,,California Manteca,California Tracy,California ES 9 REVISED 8-59 .3M 3-'63 F-RCD.