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rUK UFFICE USE: ------------------------------------------------------ --------------------------------------------------------- PLICATION FOR SANITATION PERMIT Permit No. -- -----_-� -------- _----------- - - -- (Complete in Duplicate) This Permit Expires I Year From Date Issued Date issued Application is hereby made to the San Joaquin Local He l+h a+h District for a permit to construct and install the workhereinherei�scrib d. This a plication ism de in com Iia c with County Ordinance No. 549. ("> JOB ADDRESS A LOCATION----------- - Owner's Name_____ _ w ______________ ___________________"_____ _ - --- --- -------- -- --- �-----r----- Phone-----•--------- --------------.. Address--------------- -- ---- '�" -- �- -- 1_ '' �- -- 1 Contractor's Name ` _ -------•-----------•------ t L., Installation will serve- Residence ❑ Apartment House Commercial Trailer ' "' Phone........- -7- -- -- -�-- ❑ iler Court ❑ Motel ❑ Other Number of living units;;________ Number of bedrooms -------- Number o aths _ Lot,size Wafer Supply: Public.system'';,❑ Communitysystem n ------------`--"" I Character of soil to a depth of 3 feet: Sand Ej y Gravel ❑PCiva f LoamDepth fClay Loamater E] Clay ft. _ 1, Previous Application Made: (if yes,date_____________ ) No ❑ New Construction: Yes ❑ No Y ❑ Adobe[] Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ ❑ FHA/VA: Yes ❑ No ❑ f I ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well___;' _-/Distance from f6ydatiopl_-_--" a"_ It --Material----- - `-t',�.._ - No. of compartments--_---- �-------- S_ _ Dispos Field: Distance from nearest well _b--"� '• ' fi r x Ligwd depih___".___-Cr(----- "--------Capacity_- E)_G cyo Distance from foundation____�f:--- Distance to nearest lot line_4,_. Number of.,lines----------/ Len Length of�each'•Iine__ g 4 W IY---------j,=------width of trench- - t Type of filter material Depfh,of filter.}material__-,-/i8_ ----Total length--------- ""�__"_____"" """ Seepage Pit: Distance to nearesfkwelL "_ Distance from foundation_"____ _____________Distance to nearest lot line____________-___ ❑ Number Of --------- material--_----"- ------------size. ;Diameter_ Depth------- ---------- -------- Cesspool: Distance from nearest well------------------Distance from foundation._.__-----" F Lining material-- ------------------------- -4— -_ ---- - Size: Diameter Depth_ _ _. ` _— i Liquid'Capacity_. '- ---------.--gals. Privy: Distance from nearest well__.__"-___._"_.._______"""_�__ _ _ ` 'r'-"'� �- - -"---Distance from .nearest building Distance to`nearest lot line________ ________ _ ""--. L . "—'Remodeling and/or repairing (describe)_______________ - -------------------- ---------- - --------------------------- i - ________________________ -------------- --------------- ...___.- s r ¢ ------------------------ ------------------------------------- —'---'------------------------r---------- ---------:---------------•----•----_____-__'_.___....__...___._-_ I,hereby certify at I have:prepared this application and that fhe work will be done'in accordance with San Joaquin County ordinances, State ws, nd rules and regulations of the San Joaquin Local Health District.' (Signed) t� Si ned) - ------ L ....... ---- ------------- ----------- . Y= - - -•---•----- x------ Contractor) or ---------•----(Title)--------- --------------------------------- (Plot plan, showing size of lot, location of system in.rel ion to wells,.buildings, etc.,.can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ - ------------------ ' = = - DATE--- - r --------------- ----- --------- --------------------------------------- ----- --- - ---- ------------ -------- --- -------------- �-------. DATE----- ----------------- BUILDINGPERMIT ISSUED--------- -- ------------------ - --- ------ DATE------- Alterationsand/o-r recommendations: --------•------------------------------------ ii _ s FINAL INSPECTION 8Y:_ ------ Date--../_ - �Gy -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT -1601 E.Noxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISER 9-59 3M 3-'63 F.P,CO. 'I