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FOR OFPilt _ , /--------� APPLICATION FOR SANITATION PERMIT Permit No. 3 J.. . ------------------------------------- (Camplete in Duplicate) ' ----------------- - Data issued ... f l - This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct4infhe work herein described. This application is made in compliance with County Or inance( �. 5 t �„ -•-- JOB ADDRESS AND CATION 67--- c=95 7 r: - Ph, ----------------------- Owner. Name-.--- - -•---- - ---- ------ - Address------------- � --_--- -----•-•------- --- -• ---------------.---•- - - --- - - ••------ Contractor's Name----------; _------•--••-•-------------------------------_------- Phone e .. Installation will serve: Residence Apartment House [I Commercial (3 Trailer Court [I Motel ❑ Othe [I Number of living units: __j---- Number of bedrooms,_3--- Number of baths .I..__ Lot size ---.1 _�- ..7 ------ ---------------- Water Supply: Public system Community system ❑ Private E] Depth to Water Table . ft. c Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ k Previous Application Made- (If yes,date--------------------) No'M New Construction: Yes ❑ No FHA/VA: Yes [_1No TYPE OF INSTALLATION AND SPECIFICATIONS: 'l (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank:. Distance from nearest well------------------Distance from foundation-------------------Material------------------------------------------------ ❑6CLS`{ NJ No: of compartments----------- Size --------------------------Liquid depth---- --------------•------Capacity----------------------- Disposal Field: Distance from nearest well----------_-------Distance from foundation-______..____---.__.Distance to nearest lot line--_------------- iSt-iNy Number of lines-_----------------- -----.Length of each line.---------------------- -----.Width of trench------------------ p Type of filter material--------- -------------Depth of filter material--------.-------------Total length--'--------------------------•--- ----- 0 Seepage Pit: Distance to nearest well--4N _____Distance rom foundation_-�___ ta�ce to nearest lot line_-, -- _-__-- Dep+h_ � Number of pits-��_�l�--Lining material-J�B�-��------Size: D-ssameter______________-------_ �--"---` k` ------------------------------------- Cesspool:4 Distance from nearest weH _______Distance from foundation__-_______-_._:____.Lining materia Depth -------------------- .-Liquid Capacity------------•--------------gals. Size: Diameter---------`--------------------- - ----- ❑ ------_-._Distance from nearest building-- --------------------------------------- Q Privy: Distance from nearest well_______- �__._.____________________- ❑ Distance to nearest lot line ----- -------V------------------•-------------------------------------------- f r Remodeling and/or repairing (describe) " E---------- ------•------ ---- -•--------•----•----------------------------------•-_---------------••--_-•-----.....-----------•------_`------.....------------------------------_-••------------------------------- ---- ` _____________________________________________________________________________________________________________________________________________________ ________________________________________________________________ 1 hereby certify that I hav ep ed +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es and gulations the Sa aquin Local Health District. o (Signed) -- -----(Owner--- and/or Contractor) tBy: --•-- - - ----------------(Title)------ ------------ --p---------- - (Plat plan, showing size of lot, location of system in rel tion to wells, buildings, etc., can be pl don reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ ---------- ----------- ------------- ------------ - ---------- DATE-----a------&------le-I----------------------------- REVIEWEDBY-------------------------------------------------------- ---------------------------•--------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------- ---- DATE--------•--------------------------------------------------- Alterations and/or recommendations:---:---------- ---------- - ------------•---------------------------- FINAL INSPECTION`BY:':_C_=.----- -- y -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 I M E8-9 REVISED 6-69 F.P.ro.2M 6.60