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FOR OFFICE USE: - ---------------------- ------------ �: _�• L. (� -,.--.-__--------------- APPLICATION FOR SANITATION PERMIT Permit No. -.- IF----- -------- Issued ------------ [Complete in Duplicate) .- ..�..----_-_-- This Permit Expires 1 Year From Date Issued Date ...... Application is hereby made to the San Joaquin Local Health District for a permit to construct and inn'tall th w_ ork•herein described. This application is made in compliance with County dinance No. 549. �'1� ° O/h.-� r -- / G� � JOB ADDRESS A LOCATIO --- ----------' --1----------------------------� �— Q�'t � --. .... . � --------•----------------------------- ----------------------------- ---------- Phone.......---.fa4F9_O..J' Owner's Name....-------- �v==---•--- ------------------------ -------------------------------------- �- - -•-•-----------�---Z ---------- �T �� Phone. .---- t?_ ...II.. Contractor's Name... .....•-.. Installation will serve: Residence ❑-11kp-artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -.I--'Number Number of bedrooms _-fes-_ Number of baths _. __ Lot size --- 1-----x-••-` l Q r ------- Water Supply: Public system ❑ Community system ❑ ,Private 0Depth To er Table -2-19 ft. Character of soil to a depth of 3 feet:._ Sand E]-Gravel,[] Sandy'Loam Clay Loam ❑ Clay ❑ Adobe Hardpan C] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T I' {No septic tank or cesspool permitted if public s'wer is available within 200 feet. eses" r ft ll_.___Distance from found __. ation _. _.__©_-.Material_____________________________ ______________ � from nearest we � p No. of compartments_• - -------------- Size _� _3 --.---Liquid depth- ---{---------Capacity-- � __... -- Dispa I Field: Distance from near t we Distance ftm foundation. ... Distance to nearest lot line... _... r Number of lines_.._ -._ Length of each line_ _t?._____. a_____.Width of trench_=_. _ _________________ hype of filt ial .��--De-Depth of filter material__-,/- _ q� t Total length.....,/�.Q_.;�__________________ l p _ �. '..Distance from oundation___�. ___. Pit: �stan .� rest e .__ Distance to nearest lot I'ne_________________ Num a k -- ling material__'-----_-Size: 94a+e4e4n''�.:�_��__De th-_-1-�--'*----------------`- Cesspool: - Dist tom nearest weL________________Distance from foundation_-._____-________..Lining material....__._____-._.____....._.______._.. ❑ Size: Diameter-------- -------:-------------------Depth__..'------------------------------------------- ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building------.___________--_________-.------_.-. ❑ Distance to 'nearest lot line-------------------------------- ------------------------ ------- -------------- Remodeling ---- Remodeling and/orirepairing (describe: ---------•--- -•----•-------------•----------------------•----------•-------------------•-------•---------- ....................•--------•-------=-------------------- --------------- -------------------------------:-------------•--------•--------------------------•------•-----------•------------- -. --------------•---------------=---------•I-•- -....----•-•---------------------------------------------------•----- - County0� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State aw an ules and regillations of the an Joaquin Local Health istrict. [ �+ njjg;4 tr tor) Si reed on ac [ ---- -- ---- - - ----- -•--------------------------------- ---- - ------ _ �..�--. {,/Ciel (Plot plan, showing size of lot, location of system in r at" , buildings, c., can be placed on reverse side). , #� FOR DEPARTMENT USE ONLY DATE--------- APPLICATION ACCEPTED BY ly .. ..................... REVIEWEDBY----------------------------------------------------------------------------- ------------------------- ----------%------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------•----------------------------------------- DATE----------..------------------------------------------•---•- Alterations and/or recommendations---------------- --------------------- -----_--------•------------------------_---------------- -------------------------------------------------- --------------------------•------------------------••---------------------------------------------------------------------------------------------r----------------------------------------------------------- FINAL INSPECTION -----•------ - � / ---------- Date .. _ .r(�. -------- ------------------------ ----------- BYa!�-=�-"�"�"�`-_--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Mantecar California Tracy,California _x ES 9 REVISED 8.59 2M 5-62 A LAS