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FOR OFFICE USE: k �?+ --__-..-"____ ________ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------:--------------------- -- (Complete in Duplicate) Date Issued ----- Application ___- A• lication.Is hereby made to the San Joaquin u�eLoctal Heal�-h Dit Expires I st From Date Issued pp y q ct for a permit to construct and install the work herein described. This application Is made In compliance with County Ordinance No. 549. } J08 ADDRESS AND LOCATION__,, ®~ 1 � !"A -----------_--.--_ Owner's Name......... ..:. .c Address - R' �i _ Contractor's Name----- 'T`-•-------------------------•-----_ f -.--------.-_- __- --- Phone...................I......•-------- Installation will serve: Residence 10'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms,-_" Number of baths .iL__ Lot size -__l4.cry_--_______ -------------- Water ___________Water Supply: Public system ❑ Community system ❑ Private Er-bepth To Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan Previous Application Made: (If yes,date--------- ---------) No New Construction: Yes ❑ No 21' FHA/VA: Yes ❑ No EEf`" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation....................Material___________________--_______----_-.--_______..__. 7114 No. of compartments----------"--- - --------Size--------------------------------Liquid dep.th----------- --------------Capacity--•-------------------- �- Disposal Fi,yId: Distance from nearest well-- - �--Distance from foundation_.I�_________Distance to nearest lot line..±?..._,..... IJP/I t Number of lines..........,_ -____ ____-g. Length of each line.._._ dr_ __,________.Width of trench.__r2.. _�._________________ �� Type of filter material _ N.Depth of filter material..__ �--`_._Total length------Fr-_____________-____`____ Seepage Pit: Distance to nearest well_-Z_/�-_._Distance from foundation_____ _____________ �p Distance to nearest lot line_` ___Y______. ®/r Number of pits______ ____________Lining material__ ! /!-Size: Diameter-____�Z.-__"-------- Depth_. _._____-_---_____- (Q Cesspool: Distance.-from nearest well_-----------------Distance from foundation"-------------------Lining material__-____.____________________________ ❑ Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------____----Distance from nearest building--__________________________________-__--. ❑ Distance to nearest lot line--------------------- -0--------�- - Remodeling and/or repairing (describe): -------- -----------••--•---•- --------------------------------------------------------------------------•---------•---------•--------------- -------------------•-••-----..-_-_------.-------• ----•------------•---------------•-••--------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - ` ------ ----- f ---•-•------ ----------(� Contractor) Br------------------------------------------------_-------- - _---------------- [rile}.....��.�2/1 (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r. t. APPLICATION ACCEPTED BY____-_ _____ __ DATE -- E_J . __ REVIEWED BY--------------------------- =`. QATE-----"-_----------------------------___-------------------- BUILDING PERMIT ISSUED :--D-Ar?T ---:--- -••- --------- -- - .----�� :;Y..----" "Alterations andor recommendations:______ C- = ------------------------- -------- - -------- ------ _. �...._------ . " ----------'----- - ---y ✓ -C ------------------------------I-------- ------ ------------------------------------------------------------------------- FIN,,�L INSPECTION BY--..------- ---- - -•--- --------------- -------------------- DaW----------------------- ------ ----------------------------------------------: SAN JOAQUIN LOCAL HEALTH DISTRICT " 130 South American Street 300 West Oak Street 124 Sycamore Street d,... 205 West 9th Street Stockton,California Lodir California Manteca,California' Tracy,California 6 i ES 9 REVISED 9-59 2M 5-42 ATt-A5 - +�-•�.h A''' _