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FOR OFFICE U�& v � APPLICATION FOR SANITATION PERMIT Permit No. ... ....... ----- Duplicate) (Complete in P Date Issued ,_b.r.. Z" ........... This Permit Expires i Year From Date Issued Application is hereby mtl-the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made etriipTiance with unty Ordinance No. 49 5' - t1_,0 - ! JOB ADDRESS AND CATION------- • -- ��J � � , ! r�---- --------------••---• �. //, se- 1PhonOwner's Name-------Address........ ................ ..:...........: �----------- •----.. .......-------•-•-•---•----------------------------• -----•-------•-------•. --- Contractor's Name------- .-- _-- Phone----------- 1 Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i } Number of living units: ___ __ mber of bedrooms Z— Number of baths ... Lot size -------- Water Supply Public system a Community system ❑ Private ❑ Depth to Water Table 6-/ 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 0o E] FHA/VA: Yes E] 0 k TYPE OF INSTALLATION AND SPECIFICATIONS-. � (No septic tank or cesspool permitted if public sewer is available within 300 feet.) ` S,-ptic Tank. Distance from nearest well...— _.Distance from foundation-/A------- Material____ ____,C? -.r..F. �.......... No. of compartments_________ - _ Size._ _1 _,.. Liquid de th___._ Ca aci Disposal Field: Distance from nearest well._-—:_____Distance from foundation "......Distance to nearest lot Number of lines____________ Len #h of each line.___.__ n $ ®' - 9 � �.._ Width of trench "..��? x I --------- �� 3 Type of filter material._._ _�?✓__Ts2_CVDepth of filter material____ _.-.---------Total length___�..:..J................. 4 Seepage Pit- Distance to nearest well---------_---_Distance from 1 founation___ 2__........Distance t o pjqarest lot line_i-__t _:__ Number of pits material e: a ,6epih----- � --•----------.-_-_-.- sizDiameter__ti --t-719- i . i i Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material.._ .......-_...................... , ❑ Size: Diameter------------ -------------------------Depth----------------------------------------------------Liquid Capacity...........----------------gals. Privy: Distance Irom nearest well-------------------------------------------------Distance from nearest building--------------y- --------------------------, ❑ line. p• Distance to nearest lot line_________________________ __ - Rem eling and/or repairing (describe):------- -------- rt�L�:�-•-•--... ----------- ------ r=-� r --- J -- •---•- -� - ---------- ---- ` "d I her y certify that I h e prepared this application a that the work will be done in accordance with San Joaquin County, ordinances, State laws, an rules and re ions of the San Joaquin Local Health.District. (Signed) __�'_. _ 7J.... :_. . 7"P.- --._-_Owner and/or Contractor'rt By:.-•---•-------_----------- ��_y4�Jei (� � �' � [Title} �/�-�?.E?�� .(Plot plan, showing size of I cation o .in relation to wells, building ., can be.placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.- -------------------------------- DATE---/a---- "_ - -------- ------- -- --= REVIEWEDBY------------------------------- ---- - ----------------------- DATE.------••--•----"---•...................................... .. BUILDINGPERMIT 1SSUED---•-----------------------------------------------------------.......................................DATE.----------------------------------- ---------• - AFFerations and/or recomme dations:-----.-._-- -----__--- -- 1 �{ f� .........................1.-------------- ---------- ------- --------- --------------- ----------- ----- ----------- - ----------------------------------7-------------------------------------- l FINAL INSPECTION BY:-.- -------- SAN JOAQUIN LOCAL EALTH DISTRICT 130 South American Street 300 west Oak Street ` 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California . ' Montsca,California Tracy,California i ES 9,.REVISEo 8.59 8M 5-61 ATLAe Oh 1