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rUx UN-ILL USt: u APPLICATION FOR SANITATION PERMIT Permit No. ./ ---- --------------------=.-------------------------. (Complete in Duplicate) �} --------- This Permit Exaires 1 Year Froin Date Issued Date Issued tl Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc`rbed. This application is made in compliance with County Ordinance No. 549. • j© JOB ADDRESS AN LOCATION - _ -- - U� � .�• r - ------ -------------------- Owner's Nam A `'� i ------------•------- ..---_... Phone---------- Address -b�_�__-.Q_�FQ_O(® -----..._ ) 7 ----------------------- f --•- ------ -------------- ---- r r+ .. j y ^ ---e_-------------_---------------------------------------- Contractor's Name-----=- j � _.---- Phone. °il Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court I] Motel ❑ y Other-❑ ,Number of living units: _ ___ Number of bedrooms --- Number of baths J----- Lot size ____- _ fir � ------- ' Water. Supply: Public'system ❑ Community system ❑ Private �epth to Water Table _ ___ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Cla ❑ ❑ y ❑ Y �y Ll Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dcite:----------- -------] No ❑ New Construction: Yes ❑ No ❑ FHA%VA: Yes [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___o'0-f___Distanf from foundation--- 1 i No. of compartments-_____.`�-------------Sizes__ --_ --- X `' Liqurd depth -- ----------Capacity---'y-�--• rl / r p a field: Distance from nearest well._..°�___._Distance from foundation-_____ ___.Distanca to nearest lot line`_. is os Number of lines_1------------ f I _-.___De Depth of filter material------ length______- --Q-{ -• --_ _ i Length of each line___�a-______.____ Width of trench_-------------- ----------- Type of filter material______'_ p � -------- Seepage Pit: Distance to nearest well------_---------------Distance from foundation-------------- p ----•- ❑ Number of pits--_�____._._-_--_____Lining material_____--- Distance #o nearest lot line__-______- Cesspool: Distance from nearest well-----------------Distance from foundation Diameter_=._ ming mat DrlaLth ----i------_-----__-i i El Size: Diameter j ---------Depth--------- - ----Liquid Capacity ................. ------ ---- --- gals. C Privy:' Distance from nearest well___ __-- _----------------_----Distance from nearest building------ -.1 __-. ❑ Distance to nearest lot line_____________________________ -------- --------- Remodeling and/or repairing (describe):------------------ --------------------- # t ----------------------------------------- r •-------------------------------- 1. i :f -. - :�tf------------------------------------ ;--_--------------------------------- ---------------------------------------- - ----- ---------- --- ---- --- -------•--- ---------- ------------- -- ----- --------- - Y pre ared this a application and that the workwill be done in accordance with San Joaquin County I herebycertify that I have ' ,ordinances,. State la an rules and .regulations of the San Joaquin Local Health District. l Si ned ; ------------- ----------- [ 9 } I • -•� rand or Co ��- _ B � -- - _ --- ------------- - --------�----- ------�--- - ne / tor) ------(Title)-------------- -------- Sd\ i Pot plan,showing-size of-lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). ' ' t r 1 FOR DEPARTMENT USE ONLY APP[ [CATION ACCEPTED BY--- -------------------- -- -- ------- ------------ ----- DATE..... �------------ ---r----� REVIEWED BY -------------- .. = ----- DATE. ----- -- BUILDING PERMIT ISSUED----------------------------- _-__ --- = - ----- DATE--------------- Alterations and/or recommendations:__.. -------------_----------------------------- - 1 -------------------- ---------- ------------------------ I - FINAL INSPECTION BY: - - - •------- Date_ _'_�'_-- 5� _ r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Ffaxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.p.CO. -