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FOR OFFICE USE: 35� r_ APPLICATION` rOR SANITATION PERMIT Permit No. -- ---------------••---- f Duplicate)'(Complete in ----- -- --- �- - -�-- Date Issued __- -7��- � y This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descn e . This application is made in compliance with County Ordinance No. 549. -------------------------------- ' ----------------------- JOB ADDRESS AND LOCATION__ C� - ---------------- f ---------------------------------------- Ph Owners Name---- (�i► ' -----------------•--- Address- ----- ...°"< -_. ---•• - ---•------------- !/ d ----- ------.------------------------------------- ---------------------------- ._ •--- Phone Contractor`s Name_______-__t_ __ __ _ i �.,� ` Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Lit Apartment House ❑ Commercial ❑ � Lot size Number of living units: :,"" Number of bedrooms L. ._ Number of bat}is �----"""-" Community system [��rivate C] Depth to Water Table __ _- ft. Water Supply: Public system ❑ £ y y Clay [I Adobe lardpan C3Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ElCla Y Loam ❑ FHA/VA: Yes ®.�ido ❑ Previous Application Made: (if yes,date--__---------------) No M,-"New Construction: Yes [L `10 ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: F, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic Ta k: Distance from nearest well___`------Distant from foun�datiLiquid n ur -• th_.____ Capacity_t��------- No. of compartments- '--Sizeto�_±e_ - q d dep ---- ------ F °r.,... /� istance to nearest to line. "" Q pisposal Field: Distance from'neare # well____._______.. -Distance from foundation_/&4 Width of trench-- ------------------"--------- f❑/ Number of lines___ ________________ __ _" # Length of each $ine_ (�-------------- f Total length �i ------------------------ YP / 6 �" "" Depth of.filter material____! --------- T e of filter material_ -"/ } -" -______.___.Distance to nearest lot line AP st: Distance to nearest well____ --------Distance from fo ndation__�,� � Depth_---------------- oQ Linin material_ ___ - --Size: Diameter- Number of pits---A-------- - 9 a�" ___ Distance from foundation . ____________________Lining material_..___.-----------------.----------- Cesspool: Distance from nearest well---------------- . _Liquid Capacity_ ---- ' gals. El Size: Diameter--------------------------------------Depth _ _.-"Distance .from nearest.buildin Privy: Distance from nearest well__________________----------- ❑ Distance to nearest 4ot line------------------------------:- k - . -------------------- Remodeling and/or repairing describe): . ---------------------------------------------------------------- =-------------------------------------- - f0 ------------------------------------i-------------------------------------------- - ----•--------------------- -------------------------------------•------------------------------------_------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a ordinances. State laws, and r les nd regulations of the San Joaquin Local Health District. � a cfi(��F.�,gyC ntra or) (Signed)----- (Title)-- �"' - ---------- ---- By'---------------' 6ui1d'+ngs, etc., can be placed on reverse side). (Plot plan, showing size. of.lot,.location of sysf in.relation to we11s, FOR DEPARTMENT USE ONLY' = ---- - DATE------��/; --------------- ------------ APPLICATION ------------- APPLICATION ACCEPTED BY = DATE-------------------•---------------------------------------- REVIEWEDBY------------------------------- - -- - - ---- ------------------------------ DATE------------------•----------------------: ----------- BUILDING PERMIT ISSUED-------------------------- -------------------------�- ._ Alterations and/or recommendations: `-� = _ --------------------------- ------------ - _--r -- - --- `' --- �' -------- -- J — -L --------------- ..._..._.__ 1--: � --- Grp- = . U - - .... �:• - Date------- --------------------- ---------------- ---------- r FINAL INSPECTION BY------ -------=----- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1401 E.Har:ellon Ave. Trac California Stockton,California Lodi,California Manteca,California y, ES 9 REVISED 5.59 3M 3-'63 F.P.CG. +-