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FOR OFFICE USE: , ��. _ ------------________ t► _--_-- APPL ICA710N FOR SANITATION PERMIT Permit No. ...l.[r;fit'. ___ ---------------------------------- -- ---- ------------- (Complete in Duplicate) �� G 3 -------------------_ ._ ..__ -This Permit Expires 1 Year From Date Issued bate 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. JOB ADDRESS ANDOCATI =_ - - € ----------------•------------------------------------------------------------------------------------------------ Owner's Name -- - - - ------------- Phone------------------------------------ Address---------6",R•f---- = P Contractor's Meme Installation will serve: ResidenceApartme�nt'House Com'm`ercial ❑ Trailer Court E] Motel [I(Other L]Number of living units: __l__ Numbe oF•• Um f bedrooms _ Nbe f'baths __ Lot sizef � �_____________________________ Water' Supply: Publics stem Community. s stem ft, � Y ❑ y �Priv)to ❑ .Depth to Water Table _ - Character of soil to a depth of 3,fed,-/Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ._j Previous Application Made: (If yesldcite....................J No New Construction: Yes g?"no ❑ FHA/VA: Yes ®�— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:=. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well---_`-----._:Distance from foundation_ . No. of cornpartments_...9- ------ ---_---.-„Size-"____��,�_:___Liq ic! depth ---- -------------Capacity..4�(a_-_._- Disposal Field: Distance from neares wefl.....______-____Distance from foundation-14!4---___.-Distance to nearest lot line-_ ..... Number of lines__`)_ =-------te�gth of eaCis`kine __ _f „ , -"Width-of-trench.._ ---------------- i Type of.fiiter material_ __] Depth of filter material-_ 'F } -�-----------Total length- --------------- � 1 Number of pits---- -_ Linin material_ 995!( y._Size: Diameter----' Seepage Pit: Distance to nearest well _._ _: Distance f m foundation___.. ..___-_ Dista ce to nearest lot line- ____ f Cesspool: Distance from nearest well-----------------Distance from foundation___________-----..Lining material--..___-_----_-----_-_______________- ❑ Size: Diameter-----------------L---•- ------Depth---- ----=----------------------- - -- -_-----------Liquid Capacity- -------------gals. 4 !' t � APrivy: Distance from nearest 'ell__________---------------------------------------__Distance:from nearest building ---------------------------------------- W! l Distanceto nearest lot line------------ - --------------------------------------------------------------------------------------------------- ---------=--------- � . _ .. ! s I Remodeling and/or repairing (describe):------ !_ �� 'a --------•------; ,z i ------------------------------------------------------------------------ i --------- -------------------------- ------------------------- I _-- -----------------------------i 1---------- ------------------ --------._.__---'----------I---------- 1 hereby certify that I have prepared this application and that the work wilh be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Hea h-District. ... i (Signed)-- ---_------_:{ ,/or Contractor) By:-------------------------------------------------------------------- --i4-- -�---=----------- - (Plot plan, showing size of lot, location of syste relation to wells,.buildings, etc., can be placed on reverse side). s ROR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - �� s ---------------------------------------------------- DATE....�0 -- - 1 -7 � REVIEWED BY------------------------------------- /I -- .. ------ ------- ------------------------------------------------------ DATE------------------------- BUILDING PERMIT ISSUED--------------- -----------= --------------- ATE -- ' j 7 ” and/or recommendations a 7 ------------------ ----•------- -- Alterations -�- = ' - ---------------------------------------------•--------------------------------------•--- s }' --------------- ------ - =---------------------------------------------------------------------•-•-------------------------------------------------=---------- I- -------------------------------------------- -•--------------- -------------------•----------- ------------------------------------------------'--...._----__.----...---__.----- --------------------------------------------------------'-------- NAL- INSPECTION BY:-- ' . -� ------- Date---- 1 �I SAN JOAQUIN LOCAL HEALTH DISTRICT 11501 E.liaseifon Ave. 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED a-59 31A 3-'63 F.RCD. a i