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APPLICATION FOR SANITATION PERMIT Permit No. ../.. /-�-- (Complete in Duplicate) Date Issued. - ?'�6-0 This Permit Expires l 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 de ribed. This application is made in compliance with County Ordinance No. 549. 0-1: T, - � r 44.4a --- -------I-------- JOB ADDRESS AND LOC TION_ _ ___ _______. _ ------- - Owner's N ------•--------- ---------- Phone----------- -- ------ ---------------------------•-----••--------------------•-------------------- Address- t � - - - ----- - ---- --- Phone----------------------------------- Contractor's Name----------- - - - ----•-----------------••-- -- Installa#ion will serve: Residence Apartment House'❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ SCJ-• a a---------------------- Number of living units:4,:P- Number of bedrooms _______ Number of baths -------- Lot size __---____.--- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -rte. ft. a ❑ y ❑ y Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cla Loam Cla Adobe❑ ❑ Previous Application Made: Yes ElNo� New Construction: Yes'❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' Y 1 (No septic tank or cesspool permitted if publics er is available within 200 feet.) Dista ce fro fours ion_: -------.M*af,r�ill,Setic Tank: Distance from nearest well___- Li uid de th______ _ Capacity.. No. of compartments_._-- ! Size-- err q P. -� --- ____._.Distance from foundation-------------- to nearest lot Ijne.-_____..____...- Dis o al Field: Distance from nearest well--- ____- I Number of lines--____-' ------- -length of each line---_---/� --- Width of trench------ -------------- l Type of filter material-------- -_ th of filter"materia!___._.- ___i--_..Total length------ -- ------- o� A4 See e Pit:7 Distance to nearest well____________________Distance ro undation___.____ ___..__..Distance to nearest lot line_________________ ❑ Linin material ---------•----------- a:�Diameter-----------------------Depth--------- ------------ Number of pits.------ ------ g . ing Cesspool: Distance from nearest well______._--______Distance from foundation-------- ---- --- Li`nuid Capacity gals- ------------ als. rn ❑ Size: Diameter -----------.Depth-----------------------------------------------V-- q p tY _ Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building__________________________-________--._. (�l ❑ ----------------------------------------------- -- ------•-------------------------------- Distance to nearest lot line ----------------------------------------------------- Zlelin and/or repairing ______________T`-- �,-c.----------- p� g p 9 _ __ ------------------- --------------- �$ = j. I - r' - - - 1�- f / iC-•r tQ A... �---- _ ---- �-. -- - -------------------------------- � n Joaquin County I hereby certify that I have prepared this application and that the work will be done �n accordancewith Sa q ordinances, State laws, and rules and regulations of the'San Joaquin Local Health District: �/2j (Owner and/or Contractor) v.�, 1 {Title)------------------- ----------------------- ---- ---- --------- By--- ----------------- ----------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------: -- ---------------- r------------------------------------' DATE REVIEWEDBY------------------------------ - ---- - -------Y'------- ------- --------•- ---- DATE -�)y - ---------------------------------- BUILDING -----=--� -}�]-- - - ---= - ---- --- - ------ ---- - - DATE-------------- --- ----•- - ----------- ------------ --------------- -- BUILDING PERMIT ISSUED------------------------------------ ,. Alterations and/or recommendations_________________________ ___ ------ ----------------- ------------4 ------------------------------------------ ------------------------------------------------------------------------------------------------------------------ 4 --------------------------------------------------------------- ----------------- R ---------------------- -------------------------- ! Y FINAL—INSPECTION BY------------------------ ------ ---------- -------------- Date--------------------- - ------ - - -- ------ -------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130h South American Street Tracy, California ►JStockton, California Lodi. California Manteca, California Y ES-9-2M Revlsed 6-'59 f.P-Co.