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_ -e- OR OFFICE USE: _2I p7yQ' Permit No. APPLICATION FOR SANITATION PERMIT " --------------------- --------------- -- ----------- � (Complete in Duplicate) pate Issued ----------------------------- ------ ? 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...... �ea s ....... Owner's Name---- - -----•--- --•--------- --------- Phone.- owner's -------------------- -------------'---- ---------------------------------------------------------- -- // ArPhone. C?---/ 4 F Contractor's ame------------•-----------------------P------•----•---•-- - I ontration will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 q__ _ Number of baths0�-4 Lot size Number of living units: ___.� Number of bedrooms --/- " Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Tabl P- ft' Adobe' Hardpan ❑ Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Previous Application Made: (If yes,date-_--------"---------) No ❑ New Construction: Yes ❑ 'NO FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted, if public sewer is available within 200 feet.) pti nk: Distance from nearest well_________________Distance from foundation--_-_.__ _"--.Material._"__..._____----------------•---- Llquid depth---- ----------- ---------Capacity---------------------- No. of compartments------- ------------------Size----------•---- - Distance to nearest lot lin Distance from neares well�l�___._. --Distance from foundation�4----------- .�"""" -Width of trench.- - �+ Number of lines__-. ____-."-- ------ Length of each line__------- �� �"` ,y� _ - De th of fil#er matenal"_ �__.__.___Totai length-----.----_"--_--_ ._s�---- ----•- Type of filter materials !ll�--- P Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_".-"_--_.."__._ d ❑ Number of pits Lining material Size: Diameter-----------------------Depth------ ------------------------ 1� Cesspool: Distance from nearest well._---_-.__---_.-Distance from foundation--------------------Lining material"___.___._--__----__--_---_--- Li uid Ca acit gals, rn ❑ Size: Diameter--------------------------------------DePth--------..------------------------------------------ Privy: --- -------- --------- ---------- q Capacity -------------------• Privy: Distance from nearest well --_""---------------"__-_-----------------------Distance from nearest building"-_.__-- __-_-__-"_---.___--_--__. 9. ❑ ------------------------------ Distance to nearest lot line------------------------------------ �➢ Remodeling and/or repairing (describel:Q --> I hereby that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate I s, and rules and regulations of the San Joaquin Local Health District. (Signed)._____ caner and/or Contractor -- ------------- By: (Title) (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r� APPLICATION ACCEPTED BY----------- ------------------------------------------------ --- DATE-------- --- — �---------------- REVIEWED BY----------------------------------------- --------------------------------------------------------------- DATE-- •-�- ----------------------�---•-•------------------- --- BUILDING PERMIT ISSUED------------------------- -- f ;� - DATE-- ------- -,- - --------------------------------- Alterations and/or recommendations:_".._____: f •�'1�-------- -- ____ "- -------------------------------- ---------------------- -------- --I- ----------------------------------------------------------------/)-------- --------- ----------- ----------------------------- -------- -- FINAL INSPECTI ..._ Date----------- ON BY:.. ... .......... ✓� -------- -`�-1�,� -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 6-59 3M 3-'63 F.P.CC. J