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FOR OFFICE USE:----------------- -- ------------------- IAPPLICATION FOR SANITATION PERMIT Permit No. . ................... ' ------------------ -----------------------.------ ------- ,i - ». _,, (Complete in Du.plicate.)--,. ,— _ - _--•--a...Date Issuad _ -_.-------T- -- -__-__.------_-__._._ This Permit Expires 1 Year From Date Issued _ 'r Application is hereby made to the San Joaquin Local Health District fora permit to construct and tiall e work herein described. This application is made in compliancy i+h County Ordinance No. 549. a JOB ADDRESS AN lep LOCATION_ - Owne`r's Name Phone " _.._ __ _ _____________ ,----_-.-_"-__-------_---_----_"---____-. - - E oe Addressf ---- --------------------------------------------------------- � - Contractor's Name ... 1-----"-------------------------------- Phone ti--- -r•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ L Number of living units:�� -. Number.of bedrooms, --" Number f baths __!-_-- Lot size ----------- ---- ---- Water Supply: Public system ❑i. Community system ❑ Private [Depth to Water Tabley-6, ft. i 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 ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND -SPECIFICATIONS:.� . •s (No septic tank or;cesspool;permitted if.public sewer.is available within 200 feet.) /©--------Mat rial -- ------ --- - ----- - ------------- - Septic ank: Distance from nearest well_56---.__Disfi & wm founclati1gn__.______ _ No. of compartments______ ' Siz _ ___ �_x* Liquid depth_....`-t __..___._-Capacity__ . _-- r ------ � Dispos field: Distance frorrsnearest well.``--___-.Distar�ee from foundation--_.---�.®----.Distance to nearest lot lin __-17 Number of lines_____________ '__ 0 Length of each line------- - - --.lf---.Width of trench.----�.------ _______--"--- / 1LDe th of filter material-__s --"Total length------f_ OD................."------ Type of filter material, __ ___r N t : i lance from fou dation___._` ' Seep a Pit: Distance +o nearest well....1-0_Q__-- D' -/A-• -Drs anc��to nearest lot ljue-__--------_--.- Number of pit s-------_/------------Lining material Size: Diameter___-___ ------ Depth_- ----------------------------- Cesspool: ---------_""_ _____________Cesspool: Distance from nearest well-----------------Distance from foundation------------------".Lining material"-.___'`-.__....._.__....._....__...._ 1 }; `' Li uid Ca aci+ " --gals. ❑ Size: Diameter--------------------------------------Depth------------------------- - - , q P Y -__.Distance from nearest building Privy: . Distance.from nearest well------------ ------------------ ---------� 9--------- ' ------------•---------- - - ❑ Distance to nearest lot line------------------------------------------------------------------------------- ------------------------------------------------------ Remodeling ------ -----------------------------Remodeling and/or repairing (describe)______________________ --------------r---------------- ------------------------------------------•------------------------------------ ---------- ------- ----------- I hereby certify that I have Pr pared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules d regulation3inrelation e S Joa u Local Health District. - ----------------- r Contract (Signed)-------- -- �! deo or) Sy:-------- --- -- • - - --------_---- ------ ------------------------------- (Titl p ------------i (Plot plan, showing size of lot, location of system to Its, buildin buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY, s� ----------------------------------------------------- -------------------- DATE--- ' REVIEWEDBY--------------------------------------------------- ------------------------------------------------ -------------------------- DATE---------- - -- -�-------- BUILDINGPERMIT ISSUED-------------- ---- -- --- ---- ---------------------------- DA•TE. --------=---------------------- l Alterations and/or recommendations----------- -------_--- -----------------•-----------•--------•--------------------•--•------•---------------------------------------------- �y !j%� y 1 le M op FINAL INSPECTION BY:: ------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street i Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CD.