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FOR OFFICE US APPLICATION Frit SANITATION PERMIT Permit No. ----------------- ---- ------ ��ff/ --------------------------- -- ------------------------ (Complete in Duplicated Date Issued ....l.,l 3 • E�?� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perA,,, onstruct and install the work herein described. This application is ma a in compliance with County Ordinanc No. 549. JOB ADDRESS AN L ATION I Owner's Name--------- -•-- -•--- - -----------0 —. Phone � f.. Address-----•--------•------------ -•-• ..............----- ------------- --•--- ........ Contractor's Name....-_ - .. l..!_i_Q �... Phone �7Q.. I Installation will serve: Residence W!-Kopoartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ f Number of living units: .----- Number of bedrooms__ Number of baths I_ Lot size .-------- ........... ....ZI. .....:.. Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Tabl _.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: (if yes,dote__.------------ ----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ ; TYPE OF IINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S : Distance from nearest well-----_-----------Distance from foundation--------------------Material_________-_._---_______----------..__....._.__... No. of compartments----------------_------ Size--------------•--------•-------Liquid depth--------------------------Capacity-----------------. s pose I Distance from Weare t well-( .Distance from foundation...�B..........Distance to nearest lot line____ r Width of trench___. .__�f Number of lines_______ ____ ________-_--.----'-Depth _ _ _____Length of each line_��___•. W� �-------•-•-------- Type of filter material______ __ ___ __ ____Depth of filter material___---��____Total length_�� !__............___. 0 ._____Distance from foundation.. _ � _ ..Dis ante to nearest lot line e s Distance to near st well._ _ -40---- -_ � ------- � ------ , ANumber of pits..-._______._-___-Lining material__R-0� __-----Size: Diameter----sOd>-____Depth_4�'!............... .� Cesspool: Distance from nearest well_________________Distance fro oundation--------------------Lining material..-_--__-_--.-.-..__________--------- \ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity--------_------------•---.gals. r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______.....---_____._..-__-_.-_____...... ❑ Distance to nearest lot line----------------------- ---------------------- ------------------------------.---------------------------------.-----------------•--•------- Remodeling and/or repairing (describe):----------------------- ----------------- ------------------- --------------------- ------------•------0------------------------------- •---------••--------•-------------•--------------------------------- •... .... ------------ ---- - --- ----------- ---•--------.----- ---- ---- - x ---------------- --•--------•-••---•-------••-------------- ---- •------------•------- ------------- --- ----------------•------------------------•- ------------------------------------•------•- ---- I hereby certify that I ha a prepa this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, and r es and regulations of the San Joaquin Local Health District. i (Signed)--•- . ------------- ---toe-at----------------------- r Contractor) By-------------------------- -------- -- .....(Title)........_------------------- ----------.-._-- - ------ (Plot plan, showing size of lot, location of system in relation IIs, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY ----•---•----------- DATE--------- r��' 6.1..�------------------- •---•------------- DATE.-----`----------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------- ----------------------------------------.-. DATE------------....----.....-.---------------------------------- Al'terations and/or recommendations:------------------------------------- --------------------------------------------------- •-----...-------....................................---------------- ----- f -----------------------------....------.....----....------•----•------------------•------------••-------- -------------•--------- ... ---------------•------------•- -----•---------------•------------------------- . - ----------•------------------------------ - -----------------•------ ---------------------------------------------------- ------------------------------------------------------._-.--•----------------••-•••--•••-•---- FINAL INSPECTION BY:----- •-•---------------- Date--------- ------------------------•--..._. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-61 AYLAS