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f ruK -- USE: V -- --------- ------------ ------------------------- APPLICATION` FOR,•SANITATION PERMIT Permit No. l.� a p/. - (Complete in,Duplicate) This Permit Ex fres ii Year From Date Issued D I 'y ate sued --/ — Application is hereby made to the San Joaquin Local Health District for a permit to cons k,cf-and insfall the work herein described. This application is made incom fiance with County Ordinance,No.-549. Zr. R S, _ D _ JOB ADDRESS AN LOCATION________________ -____"- S_ /AL1 Owners Name-------" /�{ ! _ - ---- - ------------- ----------------- Phone_:.--••-------------...--- -••- € Address-------- ---------23-0-------- • L ..___._____.___.•______________•________---.. --.-------------••--.-.._.__.__..- Contractor's Name___ �Apartment.H9use,❑ Commercial �� Trailer--- ---•------------------ Phone-,.,......... - ' ----- ---------:-- Installation will serve• .Residence F ❑ Court Motel ❑Other ❑ Number- .`!/] itsi4""1__ ' . ember of bedrooms -"Number of baths _ Lot size Water Supply- Public Sys tem `""' PP Y� 6F�ommunity system[] Rriva e❑'"D'epth to Wafer-Tabl_ / Character of soil to a depth of 3 .feet: Sand F�/Gravel f CJ ❑! Sandy Loam ❑ Clay Loam ❑ Clay [1 Adobe ❑ Hardpan 0 ' Previous Application Made: ;If yes,dote.__._.._. '�j�No � Construction:-� 7 New Yes d No ❑ FHA/VA: Yes No'O i TYPE OF INSTALLATION_AND SPECIFICATIONO y (No septic tank or cesspool permitted If public sewer is available within 200 feet.) A Septic T k: Distance from nearestwell C•{/ `Distance from found -- _ ation_ _ --__:_Material---0?�.0 No. of copartmenfs____2— ---- ize. .l�f D__X-S�Liquid deP.fh_--�--- Ca aclt nd Disposal Field:' Distance from nearest well<f,. _pistance from found _]ation__ -_____ __. i0ance to nearest lot line__,_5 l Number of lines_____--_s2—._-.--____-__-_---Length of each line__ --.1 `` Width of trench----- Ty pe.of,fiiter material------------------------Depth of filter material______________________Total length, _-_---------------------- N 1 Seepage Pit: Distance to nearest well______________ ____D.istartce,from- foundation_-._.______.Distance to nearest lot line ' c _ x.__ -------- i Number of pits------°-------------Lining material-------------------- Size:'Diameter Depth ' -------------------- Cesspool.; � 1Distance .fi-om nearest well-----------------Distance from foundation-------------]----.Lining material__.:_.____-t-----, - I ❑ Size: Diameter------ De th 11 )P 4 * I a ------ p --- ---- ------ ---Liquid Capacity_. --- -----------------I gals. Privy: Distance from nearest well_ ___________________ 1•j° Distant from nearest building Distance to nearest lot line----------------------• ------------,-�------- __-- Remo deling and/or repairing (describe'):__________________ _______ _ -1-------- ------ y----------------------- ------------------ -------------------------------- -------------------------------------------------------------------- E ------------------------------------- .___ __-______-______________-__. ____- _____________________________.______. _•_________•____ ... - - ___•_____-___-------`----------""-----`._ --------- ------•------------------`--'_ ____ ___- j _.____ j .r.------ -------•..�a---`--.------>-.. �-."=�i?----------------------•--------------_----------------------------------------------- I here6y certify that l have prepared this application and that the work will b one n accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. T ------ JI(Signed) s -. -- -- --- caner and/or Contractor) ' ---- ----- --------•---------------- ---------:_{Title).-----= ____-------------------- ____ _ _ __ ........ (Plot plan, showing size of lot,.location of system in relation to wells, buildin s, etc. can be la 9 placed on reverse side). FOR DEPARTMENT USE ONLY a i, - I IAPPLICATION.ACCEPTED BY --� j�. ___, --- - ----------------- ------------------------- DATE------- { `]REVIEWED BY---- ------- - - - - -------------------------------DATE 'BUILDING-PERMIT-ISSUEb_ ._._ ------------------- IlAlterafions and/or recomm ndations____ ___ ______ ---•- •- ---------- -------- --------- ----••----------------•------ 1. �, � ,.. ---- - --- f( ---------------------------- '4 '-------------------x.----- ------------------------------- II ------------------- ----- -------------------------------------------------------- FINAL INSPECTION . Y: t �- Z� - -- - Date- .SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 309 West Oak Street 124 Sycamore Street I 205 West 9th Street . Stockton,California Lodi,California ` E� ., Manteca,California Tracy;California f� ES 9 REVISED B-59 3H 3-'63 F.P.CD.