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FOR OF I Ou :. J� -- - --------- ----------- ------ --- APPLICATION FOR SANITATION PERMIT Permit,No. f = -_ ------------- (Complete in Duplicate) �3 -------------------------------- This Permit Expires 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 made in compliance ,with County Ordinance No. 549. x. JOB ADDRESS AND CATION--- --.- ------ --------------------------------------------------------------------- r Owner's Name------ - - - Phone ---------- -------------------- �. Address--------- ------ ----�-- Contractor's Name------ - - Phone. .... - Installation will serve: Residence ❑ Apartment House Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "/ Number of bedrooms _ --- Number of baths -......tot size . , _ ------------------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .45 Character of soil to a depth of 3 feet: SandE] Gravel ❑ Sandy Loam ❑ ' Clay Loam ❑ Clay ❑ Adobe 8Hardpan ❑ Previous Application Made: (If yes,date-- ------..--------) No E4'�New Construction: Yes ❑ No [Tj'_FHA/VA: Yes ❑ No 9� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se415' TPA: r Distance from nearest well-----------------Distance from foundation..._-_-.._--__----Material------ ------------------------------------------ . I /ff No. of compartments-'-------------------------Size-------•--------------------- --Liquid depth-----------•--------------Capacity----------------------- Disposa Field; -- -------.Capacity----------------------- DisposalField: Distance from nearest well.__.'--------Distance from foundation--.-4�.f....Distance to nearest to line-----------------W t (gTWL� Number.of lines_______ ______I--.----------- .Length of each line---AP---_-- Width of trench--, ----.-----------------_-._--W �� - Type of.,filter,mate rial-�j 0� Depth of filter material---� --------------Total length..... ..:................_ Se�p��;0-4 ��"` Distance to nearest well_-_----------__Distance from foundation----—, - ---_--Dista�`e to nearest lot line--.'�-r.--- ri Number of pits____.............Lining material./� --Size:'Diameter---_ �I-_-��....Depth___ .`-...._____-__. Cess Distance from nearest well_________________Distance from foundation....-.------------- Lining material----------------------------- ❑ Size: Diameter-------------------------------------- -------------------------Liquid Capacity----------------------------gals. I Privy: Distance.#rom nearest well-----------------------------_. Distance from.nearest building......_--------______..____---------..-. r' ❑ 'Distance to nearest lot line-------- -------------- ----- --- ---- ------------------------ -•--- -------------------------------------------------- I Remodeling and/or repairing (describe)=----------r!r 'E �G -------------------•-------------------------------------------------------•- ----------------- ----- - -- ------- ---------•----- --- ------ :_.: -------------------------------------------------------------------------•---------------------------------------------------------------------------------------------- --------------•------------------------------- ------------------------------------ -------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------- --------- 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,.,an rules and re Anshe San Joaquin Local HealthDistrict.(Signed)------- -- ------ -- --- or Contractor) --- 13 - -------'------------------y:-----------------------------------------------------(Piot plan, showing size ofJot, locationofation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY • ---`----- --� -----=------ -------------------- ----------- APPLICATION ACCEPTED BY DATE r°f- 5 ---------- ------------ REVIEWED BY------------------------------------------------------ ---- ---'-------------------=--------------- ------ DATE----------------------------------------------- -----BUILDING PERMIT 155UE0. --------------------------------------------------------------- --------=---------------------=---- DATE----- --------------•------------------------ -------------- Alterations and/or recommendations--------------- ------------------------------------------------ ------------------ ---------------------------------- ------ -- --- -- ----- = = ------------ = --0 Y --------- -n-14---------------------------------------------------------------- ..-.-.------•-•--....__ .t -��-- ---- _.-------..._.- ----------------------------------------------- -------------------- --�° -w2u�_, -------- r t-------------------------------------------------- ' -° ----------------- ------------------- ---------------------------------- - ----- ---- -------- -------------------------------------------- --- FINAL INSPECTION BY:------ t'- -------------- ------------ Date.------- C� ........... r� SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Na=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 RrLYIS6O 8-59 3M 3•'63 r.P.Ca.