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FOR OFFICE USE: --------- z 1-1--1-------- APPLICATION APPLICATION FQR -SANITATION PERMIT Permit No. ....__. .. ------------4�------------------------------7 ------ (Complete in Duplicate) Date Issued --- 1,-:?L--------------------- _---------------------------- 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. �J JOS ADDRESS AND C ION o /_- . e � --�---------------- - Owner's Name Ph.one------------------------------------ Owner's, - - oPe Address_.. r . -------- Contractor s Name = ------------------ Phone f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Coutt ❑ Motel ❑ Other ❑ Number of living units: e Number of bedrooms _A--.Number of baths 4_ Lot size �` ✓�f---- •- ,>> ,7. ft. f Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table . Character of soil to a depth of.3feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej- Hardpan ❑ j Previous Application Made:. (If yes,date--------------------) No 24-"'New-Construction: Yes 0--No ❑ FHA/VA: Yes Z?"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septicstank or cesspool permitted if public to er is available within 200 feet.) i� . - ' f Distance from foundation_ ,s� _.Material-_ L ---•--- Septic Tank: h Distance from nearest wel ______________ _ �, /�, -�--;�--- �" No. of compartments--�----------------SizevaW—OXvp- Liquid eptly-- -----------------Capacity_I ----- . � I t/ 4 , r Disposal Field: Distance from nearest well...:-------Distance from foundation-___fa_.__.Distance to nearest lot line.--�.__•____ fe t Number of lines---' -�--- ------ -Length of ea ch liner- Q`a_ -- -Width of trench.-. _._---:--------------- --�- Type of filter material —Depth o? filter material/C = Total tL I ' --.p st nce to nearest loft line-s� ----- Seapage Pit: Distance to nearest well--------- fro foundation____ _.._ Number of pits---1___._______--Lining material____, --.Size: Diameter- _�r_.__...Depth_ � CesspaolFY.� : Distance from nearest wel--------------.__Distance from foundation-----------�,_.__.Linmg material--------------------- ------------- . Size: Diameter---------------------------- -- Depth--------------------------- -ti ��, Liquid Capacity gals, i r r Privy: Distance from nearest well-_______________ ________________.._______-_.__._Distance`f.rom'nearest building____._________-___,________________-_._. ,t€ ❑ Distance to nearest lot line-- ----- ------- -------- --- --------------------------------------- -------------- ?J ------------------ ---- 71 Remodeling and/or repairing,(describe):______.._ �- ------"--"•------ F --------- ------ - p I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,.State-laws, and rules-and regulations of + e San Joaquin Local Health District. or Contractor) (Signed) ' t By=---------------------------------------------- -------------------- / 6 Title)----- ��- ------ -------- - (Piot plan, showing size`of�lot, location of system in relation ells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ / `"r`"� ` / y F �'� - - DATE------- / -------------------------------- REVIEWEDBY-----•-----------------------------•- --------------------------------------------------------- DATE------------------------------------------------------------- i BUILDING PERMIT ISSUED :`----------------------------------------------- DATE - - Alterations and/or recommendstions:__._. Q -- -----=-- = --------------- = = -• 1' ` ------- -- I -c C.. ,�.. _� -------- ---------- -- --------- - ---------- -- -•�--_�- -- ------------------------------ ---- ------------- ------------------------------------------------------ - --------- _ I s� � y � FINAL INSPECTION BY: ` rc:m ------ --------- Date---- ----- -------- ------ "-11 JOAQUIN LOCAL HEALTH•:DISTRICT i:. y J- 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F.P.CC. �'