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FOR FFI E USE: ------- - --- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- -4;-_'+�----------------------- T ._ (Complete in.Duplicate) ��-�- -Date Issued - �--- _-",.""- _ res` - �---- - -- ------ -_ -_ This Permit Expires 1 Year From Date Issued # s hereby rr d San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafiion is made in compliance-with County Ordinance No. 549. � € JOB ADDRESS AND -------------/ ------------- { ----- --�---------------- . - --------- Owner's Name------- v� ---- --------------------------------------------------- ---- --------------- - ----------------------- Phone----- ----- ---• i Address- -.:LL==== _ ==- r ,?1•�!P i -•---- Contractor`s Name----- -k---------------- ---------- . G1 Installation will serve: f Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E Other ❑ Number.of riving units: ---J-- Number of bedroom4. _ Number of baths-2�-- Lot size -7- ----.,1 Water Supply: Public,.-system ❑ Community system ❑ Private E-15epth to Water Table -------- ft. Character of soil fo..a_depth_of-3.feet:—Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: [If yes;dote---"'---""-_" ------) No 2--14ew Construction: Yes ❑ FHA/VA: Yes [t--1T0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: s Distance from nearest wee#""""-. ---Distance from foundation.-./AO -:-----Material"_C0_6-!1 -&------ ---------- t I No. of compartments".-._! ---------- --Size,� j-' ��- -Q--Liquid depth---��---------=---------Capacity----1Q.�d -. Disposa, field: Distance from nearest well_.' ---Distance from foundation-"�_ -_ Distance to nearest lot line--_--%$� ryr� Number of lines-""-"-"-_+�®: ------ Length of each line_-_/` `f-lpp"____"-".".Width of trench-. _ --_"-_"-"-"""--""- Type of filter material--_/_,o`�-r'"Gj epth of filter material-----!_-0---�-----Total length--_--y0 -__----" Seepa t: Distance to nearest well--- ---------Distance from foundation---/a!_--_--.Distance to n� rest lot line-�-'�-----_ Number of pits---- --- "-""""Lining material---__YQ�1t"-_--Size: Diameter."--5A /fir---6D�pth_��___"__________________ Cesspo Distance from nearest,weil-----------------Distance from foundation----------------__.Lining�rnaterial-----------------___--------_---- t ❑ Size: Diameter--------------- ---- --------------De th-----.------------- ----- -------Liquid -Ca acit Privy: .,Distance from nearest`-well---------------------p_-"---------------------Distance from nearest building-------------------------------------------gals. El Distance to nearest lot line----------------------------------- -- " : - Remodeling and/or repairing describe J_----"-" _ �`- - — ---- •- - _ ----------------------------------- ----------------------- ----------------------------------------------------- - ------------- -------- ---------------------=---�--=-=------------------------ ------------------------------�n-==_-=�_------•----------------------------------- �� :,,--w..�"�� Fw 8 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelaws,r ales an re lotions of fh`e San Joaquin Local Health District. (Signed) "- 4 ----_ �_"------_----_-_"------{Owner and/or Contractor) ---------------------------------------- B ------------- -------- ------ ----(Title)---------- ---------------------------- --------- , Y:------------- - (Plot plan, showing size of lot anon of system in relation to Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY-,', S t 4 APPLICATION ACCEPTED BY------C...... i5i_ - -- DATE ------------- ----------- -------------------------------------------------R`EVIEWED .BY------------------------------------------------------------------ ---------- -------------------------•-------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ------------------------- -------------------- DATE----------------------------- -------------------- ------ Alterat1io-ns and/or recommendatiyons:"-� � l -`- ---------t-------- S - - -1 "'. •- 5 a ---- ----- �' ----------- - ._. �F r� 1'�� i� _ - FINAL INSPECTION BY:------ ---------------- --- ---------- Date-. s---' i Z--`---�P-i---------- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.Cp. 3