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FOR OFFICE USE. _ f G APPLICATION FOR SANITATION PERMIT Permit No f. ....... , -----`-S- ------------`f •..��. (Complete in Duplicate) e24------ This permit'Ex ires 1 Year From Date Issued Date Issued ___. 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.riade in compliance with County Ordinance No. 549. I JOB ADDRESS AND,L'OCA710N.__ �: . ... '� ./n � ,// �`�� - ----------------------------------------- Owner's Name--- ----•--- Phone------------------------------------ Address _... Address.--....... -R. ?--- ................. ` 1 tp - Contrector's Name'..--'• -�1& �1 ...----••------------------------------------------------------------------ Phone.........................--------- t Installation will serve: =Residence V] Apartment House ❑ Commercial ❑ Trailer Court EV"' otel ❑ Other ❑ Number of living un umber of bedrooms ZrNumber of baths '_ Lot size __— ,% �- t �� Water Supply: Public system ❑ Community system ❑ Private &'�epth to Water TableNksft Character of soil to a depth of 3 feet: Sand ❑ Gravel 0—Sandy Loam❑ Clay .Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (if yes,.date--------------------) No New Construction: Yes V31"N�o ❑ PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Ewer is available within 200 feet.)-` ► Septic Tank: Distance.from nearest well-40W____Distance from foundation_-_"" �.....Material_"_.. - _ ---- No. of compartments.--___ .._-_-------Size'. i _: y'%�__Liquid depth__ ------------------ Capacity-x: 4 1 Disposal field: Distance from nearest ell-5/*.....:Distanceafrom founda ion___ ^........Distance to nearest lot line...' R_ _ ' Ile Number of lines____ __ Length c each lint ` g --•---Width of trench---r_'- - C� Type of filter material./�A{ Depth of filter material___{ f---_-_-Total lerigth_____��9rOe-A----------------------- Seepage ------------------ Seepage Pit-. Distance to nearest well___,C .---Distance fr m foundation____--_____-Distance;to nearest lot line_---+�� s .y Number of pits.-_. ____________Lining material_ Size: :Diameter___: ��_ _.Depth_-_ ------------------- Cesspool: ---- __-_--__---Cesspool: Distance from nearest well-----------------Distance from'foundation--------------------Lining material--.__.__-----_--_-_--_-_--_--___----_„ ❑ r Size: Diameter--------------------------------------Depth----:------------------•-----------------------------Liquid Capacity gals, Privy: Distance from nearest well------------------------------- I--------------- from nearest building--..-._------_----_-_-__.----.____..____. ❑ . ._. .4 ,. . ... r Distance to neatest lot line ---`-----!----------•--------------_ ---•---------- ---------- - ------ "o _• �� E Remodeling, d or repairing (describe):an / p g [ ) --Ite -- -- - ------------------------- --------------------------- --------------------- G ----- -------------------------- ---------------------------- ------------- ---�� -�- ' `'� --- = ------- -- ;�---------------------------------- ------------- .. r: _..____.. ______-.~.1-----------__ __________a I 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 regulations of the San Joaquin Local Health District. f (signed)Y• k f� i{ 'd. ------------- tor Contractor) le -- �-- --- (Plot plan, showing size of lot, location of systerrf relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------- - DATE: �Y APPLICATION ACCEPTED BY-_______ __ __ _____ _ _ __ _____ _ _ REVIEWEDBY ------•---•---•------ ------ -----------• -------------- ------ -------•------------------------ DATE------------------------------------ ... BUILDING PERMIT ISSUED ----------------------°----------€------------------------------------- DATE Alterations a d/or recommendations:------..-___-. a ------------------------------- - -- ------- �_,�--------- -------------------- ::::::::::::::::::. ::::: ::::::::::::::::::::::::::::::::: :::::::::::::::::: ::: ----------- --- ------ ----- - I .. ..I--------- ---.-- . . - .� ------------------------------------- - FINAL INSPECTION BY:--- ------ _ Date-------, -,._ -� f - r SAN JOAQUIN .LOCAL HEALTH-DISTRICT 130 South American Street 300 West Oak 5treef' 124 Sycamore Street `". 205 West 9th Street I Stockton,California Lodi,California a Manteca,California Tracy,California E9-9 REVISED B-59 F.P.GO.SIF 6.60