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FOR OFFICE USf:------------ j "APPLICATION FOR SANITATION PERMIT Permit No. .__.�__..:..__�-_-_--- (Complete in Duplicate) � --- A�. This Permit Expires 1 Year From Date Issued 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. _ -- JOB ADDRESS AND LOCATION � __--- `� := -a Owner's Name-----�77------ --- -------P------ ' ------' ------------------------------------------------------ Phone------------------------------------ -_4 ----•--------------•--------------- ► zAddress_ _ - Contractor's Name--- ---- ----------- Phone �. s . Installation will serve: ResidenceApartment House ❑ Commercial F] Trailer Court ElMotel [3Other ❑ �umber Number of living units: __ of bedrooms 7—Number of baths I----- Lot size -------- ----------------- --- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table, ft. Character of soil to a depth of 3 eat: Sand ❑ Gravel ❑ andy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date- No New.Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewtir is available within 200 feet.) tic lr� Distance from nearest well--............._Distance from foundation__.______---____._.Material-------------------__-..________-____..___._.. No. of compartments-------------------- -- - Size--------------------------------Liquid depth----------- ------------- Capacity------------------ r •r Disposal F'�d: Distance from nearest well- -----Distance from foundation-----------------___Distance to nearest lot line-------..__.____- � � 5 Number of lines------------_---------- - ----Length of each line------------------------------Width of trench----------------------------------- r +rK Type of filter material_____________ __________Depth of filter material____.___.--__-----_-Total length------------------------------------ (A,j Se pa Pit: Distance to nearest well-. --_Distance from foundation.__41--___:__.Distance to nearest lot line — 6 Number of pits.----f -_----__----_Lining material__-- y"+C, .Size: Diane#er._. �__- Depth_,,Z-4—________________ )4 ess opl: - Distance from nearest well-----------------Distance from foundation------ lining material__.-----------__...._-.-_____________ �( I►1� Size: Diameter--------------------- - -- - -------Depth------ ----------------------------- Liquid Capacity gals. Privy- Distance from nearest well------------------ ------------------------------Distance from nearest building-------__..__-._------_______..__-_-__--- ❑ Distance to nearest lot line------------------- -------- ---- --------------------------------------------------- ----------------------- D ,�f�� "l r. Remodeling and/or repairing (describe):_c .. - .> �. ...-.--/ " -- -Gtr✓-G°s*`--- - � �-��--------------------- --� --- - -- -- ------- ------------------------------------------------- --------- � = -t--------- --------------- ---- --------------- ---- ---------------------------------------------------------------------------- - -------------.--------------------------------------------------- q Y I hereby certify that I have prepared plication and that the work will be done in accordance with San Joaquin Count ordinances, State law ; nd es and;regulatio of the San Joaquin tocol Health District. (Signed)---------- � – - ----- s'.. er and/or Contractor) By:-------------------------------------------------- -------`' = ''- - ------(Title)-- ------------------ (Plot - -- - -- - (Plot plan, showing size of lot, location of systet linin relation to wells, build' st etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------- ----------------------------------------------------------- DATE---- - ' %' Z----------------------------- REVIEWEDBY-------------------------------- ------------------------------- ----------------------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommend ations:._.Y--f_$o..-.fry-1---------- -------rt-A.•. 0---•------ } tom FINAL INSPECTION BY: " R 4` ...... Qa#e `s------ c`-- -----' - ---- - --- -------I--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 6.59 F.P.CO.2M 6-60