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F F OFFICE USE.' >- APPLICATION -FOR SANITATION PERMIT - Permit No. ._7r ------------ ------- -- (Complete in :DuPlicate1 -------------- --------- -- Date Issued .( ` - This Permit Expires 1 Year From 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 made in compliance with County Ordinance No. 549 ; y�� ry 4f = ----•-- R JOB ADDRESS AN&LOCATION ---- aw Phone -Owners Name--- -1--____"_"""_""""" --".____-"""""- --•--------------------------------- i --------•---------- ----•-•-------------------------- Address7s� t Contractor's Nam ------•--•-------------------- Phone------------------.--------- R t Installation will serve: Residence /Apartment House,[] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _".�_-- Number of bedrooms'____- Number o the _ Lot size __ Water Supply: Public:system ❑ Community system'❑ Private "Depth to Waferl-0e "6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sa Loam ❑ Clay Loam 11C [:] Adobe Hardpan C3 Previous Application Made: (If yes,date--------------------1 No [ Neew Construction: Yes No ❑ FHA/VA: Yes ❑ No ®' I TYPE OF INSTALLATION AND SPECIFICATIONS: (No se fie tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic n Distance from nearest weN:""sJ "-""""_Distapce from foundation �---."..---.Material---"" "- t No. of compartments---�---------------Sizk��__:4 *Y -Liquid depth--- '-----------------Capacity e I ' Disposal Field: distance from nearest well_. Distance from foundation""16-"-"----_.-.Distance to nearest lot line------------------ .1 �. .•Number of lines-=-•- Length of each line=- --------------'-----.Width of trench.- '� `�� -------.�Jt_ - ..: --"""................ Type of filter matena"" """"-�---------Depth of filter material__,(.�.-""---_---.-Total length---_�_�'" ' r fp. r. Seepage Pit: Distance to nearest well__ Q ----------Distance from foundation--/6-----------Distance to nearest lot line Number of pits----A------------Lining mate rial_`?OA- """---Size: Diameter-"- - ._._".......Deptn"" -""""________ Cesspool: Distance from nearest well-----_---_-_--__Distance from foundation---.- ._-_"-_.Lining material""------------ ----------__ -"--"_ LW ❑ Size: Diameter------ 7--------------------------- -Depth----------------------------------------------------Liquid Capacity_-------------------------gals. Distance to nearest lot line____.-____-.-_ Distance from nearest building - -- ❑ ------------------------------- g--------------------:------------== Privy: Distance from nearest we41--.-"""""_____-_ �1 Remodelin and/or re airin describe :_ -----'------------------------------------ ------------'--------------------- =------------ -------------- -- - ---- 9 P g I .__ ---------=------------------------------------------ ------------"--------------------------------------------------------------------- '1 ----------------------------------------------------.-----------------------------------------•---- -------------------------- -- - ---------------------:_------ -------------------------------------------------•--------------------- --------------------•-----------"---------------•--------------------------------- I hereby certify that I have prepared this applicatio and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio of t San Jo quip Local Health District. I 9+ k I (Signed)----------------- --------- -- ------ - -------- --- -- ------ -----------------=---------------------- ---- ----------------------(Owner and/or Contract d/o or By:. '---------- -----`----------------- - (Title) - (Plot plan, showing size of lot, I c ton system-in-elatio to wells, buildings, etc., can be placed on-fe erse side. w FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED $Y'` - -------------- - -Cwt-!r�r------- ---- -------------------- DATE-------�--`i----��- - ------------------------ DATE -------- DATE----------`---------------=------------------------------- REVIEWED BY------------ --------- ----------------------------------- - ] ,�-y, f BUILDING PERMIT ISSUED-------- - DATE-= -- =- --------------- ---- Z —= -- .1 k---------�- --- --•---- . � Alterations and/or recomme-ndations:---------- ----------------------------------------------------------- aE f• ------ --------------------------------------_------- ...... . i ---------------------------------------- ------------------------ --- =`---"------------ ---- --------------• --------------------------- ---- FINAL INSPECTION BY:.. G_ rSANN ' =��-f�,-. . � ' . ��Daie...._ - - -----.:. �r OAQUIN LOCAL HEALTH DISTRICT V ; 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California + Manteca,California Tracy,California E5 9 REVISED E-55 3M 3-'63 F.P.CC.