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FOR OFFICE US : �. ��1-- ---�--�- Permit �- -----=------------------ APPLICATION FOR SANITATION PERMIT - ---------------------------------------------------- -- (Complete in Duplicate) Date Issued __r :3// _l. - This Permit Expires 1 Year From Date Issued h 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 Ordinance No. 549. JOB ADDRESS AND LOCATI N- __-.._✓___`_: ------------ ' -------------------•----- --------------------•--------•----------•-- r Owner's_Name ----- Phone Address 1 _ � --�-• - ----------------•----•----• ---------------------------------------------------•................ ----- Contractor's Name-- I -_l` rr'' `"� Phone. 4 e .5---- Installation will serve: Residence Apartment House ❑ Commercial' E] Trailer Court 1[] Motel E] Other E]t , Number of living units: ---I---- Number of bedrooms ---- Number of baths __r___ Lot size __ ---- ------- Number r Water Supply: Public system M—Commuriity system ❑- Private 0 Depth to Water Table Character of soil to a depth of 3 feef:'l Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--lHardpan ❑ Previous Application Made: (If yes,date_-_----------------) No New Construction: Yes [Zk-No ❑ FHA/VA: Yes ❑ Noe— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer.is available within 200 feet.) r Sept}er Tan[; •- Distance from nearest well________________Distance from foundation-------------------Material________---__-________._________-_-____________- 1 No. of compartments--------------------------Size------•- --•-••-----___--- --Liquid depth---•---------------------,Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance fromfoundation--------------_-----Distance to nearest lot line--------------_.. Number;of lines----- *----------------------------Length of each line------------------------------Width of trench-----------•-------------------- Type of filter material--------------------------Depth of filter material-----------------------Total length-----------------_---------------------•-- \5 _ . Seepage Pit: Distance to nearest well_�j^-�___-_-_Distance from foundation__)a............Distance to nearest lot line___ ------- Seepage �. Number of pits-----,- ------•------Lining material-, '------ Depth---------2-a----•_--------'-• Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-_--__-_-___________-------__________- ❑ Size: Diameter---------------------- -Depth-------------- - ------------------------Liquid Capacity--------------------------gals, Privy:, Distance from nearest well----------------------------------------------- from nearest building--------------------------- ------ Distance to nearest lot line------------------ -_----------•--- �Remodce,Eli.n,-g----2a-•n--d--/----�r-- repairing ---(`d--e---s:c--ri.b�e--•)-- --� ---* ----�--'.-r- _"_ � ---- --• . ----- ------------------- •--- - _ - ._ - ---•------- -.--------- ` --------••---------------------------------••------------------------------- --- . --- ---------- ,---- -- ---_---- - = - ---------------------•--•---------•----------•------------------- --- ---- _ . - ----------------------•---------------------------------------- I hereby certify,-tha+ I have repay d this application and-that the work will be done in accordance with San Joaquin County . ordinances, Sta+e'laws;,and'-rul and egulations of the.San Joaquin Local Health District. x ----- (Signed) `` ''' _-__Owner and/or Contractor I ( / BY� _ -------=-----=----=------------------------{Tit e)--------------------------------------------- --------------- L (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 APPLICATION ACCEPTED BY---- �-' � ---------- . ----------------------------- DATE- ----- ��--- --61-------------------------- REVIEWED BY--------------------------- ------ ,.- DATE_. BUILDING PERMIT ISSUED:_----------------- -------------------------------------------------------- ----------------------- DATE---------------------------------------------------- t Alterations and/or recommendations:,---- '---------------- ' -----` ----- ---------------- ------------------------------------------ ry,. � - FINAL INSPECTION BY:_:_C-_.0 _-_ , ��-�n�� 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 E&•9 REVI9 E9 8-59 F,P.0[I.2M 6-60 t