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FOR OFFICE PSE. . ! g ------- ---------- � f-.- APPLICATION FOR SANITATION PERMIT Permit No. y -------- -- (Complete in Duplicate) '<` Date Issued ... -- -----_ .__ - -_ __ This Permit Ex Ires 1 Year From Date Issued O Application4.hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati06 �s made in compliance with County � Ordinanlc eNo. S449. JOB ADDRESS AND LOCATION.. __ ___ C" _______0^ J .• _-_.. Qf� � �-------- _____________________________•---________..__ Owner's Name-- ---------------------------- � ------ Phone ... Address.................... - •..................... � fNClAk :------------.--------------------- --------- .----------------------- _Contractor's Name L_ � D �[ ` C � f . - --- ----------•-----------------••---. Installation Phone y'�4 will serve: Residence ❑ Apartment House ❑ Commerciale Trailer Court [IMotel F1 Other j} clue Number of living units: _—_ Number of bedrooms ._�- Number o _.;:-Z Lot size ____ Water Supply: Public system ❑ Community system 1% Private ❑ Depth to Water Table ________ ft. 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 6, New Construc#ion: Yes ❑ No;n FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s IA- 7 Septic Tank: Distance from nearest well__Nu/��-Distance fr9m foundation_____!(o-______.Material-_---_-No. of compartments______'Q_.__..__----_Size__!_X X__57-:_..Liquid depth________//_ __________Capacity-...W17f ,Disposal Field: Distance from nearest well___ Distance from foundation_/°%-------------Distance to nearest lot line--- _-____- _-.._-_Number of lines........ Length of each line------ ------ of trench._._.._..� __• -----••- ----_Depth of-filter material------ length____----->�-•�---__--___________.Type of filter material.._ E4 o Seepage Pit: Distance to nearest well------0 k�-----Distance from fo ndation___Xq...___.Distance to nearest lot line____ �______ i � tA Number of pits_____:___-_.._---_Lining material.. .Size: Diameter__. _ p t Cesspool: Distance from nearest well_________________Distance from foundation------------------_Lining material-------------------------------------- F1 _-.__-._-_._.._______________ -_❑ Size: Diameter------ -•-----------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------___Disfiance from nearest building______________________________.__..____._. ❑ Distance to nearest lot'line--------------------------------------------- --------- ... i Remodeling'and/or repairing (describe)------------------------------------------------------• --•--•...... --------------------------------------------------------------•-----------------------------------------------•-------------`------------------------------------------- --•-----------•-------------------------------------- 1 I''here6y certify that I have prepared this application and that the work will 6e--done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' I (Sig'neld} --------------------------------------------------- #---------------------- ----.--.(Owner and/or Contractor) r By� {Title} (Plot plan, showing size o lot, location of system in re ation to wells, buildings, etc., can be placed on reverseside}. FOR DPARTIvI T USE ONLY Imo. APPLICATION ACCEPTED BY y- -------------'------------ DATE- /Z/-<-7/_ _A---0--------------------- Rs=VIEWED BY __._.. DATE--------------------- -------- ----- - BEJILDING PERMIT ISSUED. = a`-y---- - DATE------------------------------------ - m. , er ttons and/or recommendations:,__________________________ _'`_ ----_-- -*-_ _____________________o-______._......_ f J__ ! ______._-------_-__•----•-______---- ---------- _ ______._ _ --�___- ------ _•-___r_ .______ _._-.. __f�a.__._ _-------------------------._______-_______-___ ------ --- - --------------------------------------------------- - ----------------------------------------- ------------------------------------------------------------------------- FINAL --------- ------------------------------------FINAL INSPECTION BY: ---------- Date-- = Y �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5-9 REVISED a-59 F.P.M0,2M 6.60 ,