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FOR OFFICE USE: --- F ---- _U - --------------- Permit No. APPLICATION FOR SANITATION PERMIT -------------- ---,_ (Complete in Duplicate} Date Issued _-r __° �3 _ _-- "._____- This Permit Expires 1 Year From Date Issue 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. C�w E.0 7-H S T , SJC3 JOB ADDRESS A OCATION_ �Q _�- - `�--- ---------- Owner s Name__..- • _-- --- - - --• -------•----- f --------- Phone-----.----_----------------------- Owner's r_... --------------------------------------------------------------------------- Address_..--- �*� f ....---- Contractor's Name---__-_-• •--- Phone--------------------••--....---• l Installation will serve: Residence Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other �❑ / _ham '' Number of living units: �'" Number of bedrooms �" Number of baths ________ Lot size ------------------.__ - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A__-_ ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe), Hardpan ❑ f Previous Application Made: (if yes,date--------------------1 No N� New Construction: Yes 6 No ❑ FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fettle Septic l Tank: Distance from nearest well----LZT_Dista2�from fou aionMafertia ---------------------------- No. ��---; No. of compartments_ .�--------------Size--- Liquid depth__-___4-...- -----------Capacity.._ 9 i Disposal Field: Distance from newest well----J7��--_Distance from foun laGion. '- •--Distance to nearest lot line___9_____-..___ Number of lines--,X--:---------------------------Length of each line-�._ fn-,---�-��-------Width oftrench---��:- ------------------ r Type of filter material-------------------------Depth of filter materia--------------_------Total length-------•-------•-=---.- -----•-------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_____-_____.-.._ C ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------- ----Depth------ -------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- _______________ Size: Diameter---------------- ------------ -------Depth_----------=-----t----- _•--- ___. == Liquid_Capacity gals. El Privy: Distance from nearest well---------------------------------- ------------ -Distance from nearest b0cling__---___-----_____----------------------. ❑ Distance to nearest lot line--------------------- --------------------------------•------------------- .� Remodeling and/or repairing (describe) eq - 1_ -------------------------------------------------------------------------------------------------------•---------- ---------- ------------------------- ------------------------------------------------------- •--------------------------------------------------------------------------------------------------------------------- I hereby certify fh ;I have prepareAthis application and that the work will be done in accordance with San Joaquin County ordinances, State law , and rules and�r4g"ulations of the San Joaquin Local Health District. k / [Owner and/or Contractors (Signed)----------- Title --------------------•-------"----------- (Title) (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ------------------------------------------------------ DATE----------------------------------------------------------- rt REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE---------"_- -12" -•- ----------------------- BUILDING PERMIT ISSUED------------------------------------ -ul � DATE Alterations and/or recommendations:-------------------- ---------------------------------------------------•--------•----------- ---------- ---------- ---------------------------------------------------------------------------------------------------- -- ---------------------------------------------- ------- ------- ----- ------------------------ ------- ---- ------------------------------------------- FINAL INSPECTION BY.._- ` Date-_----------------- ----- ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California R ES 9 REVISED 8-59 3M 3-'63 F.R.CD. k