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FOR OFFIC UAE: � �L 7 __ /or ��U(o� ---------------- -------------------------------------- FOR SANITATION PERMIT Permit No. ........---------------- APPLICATION _________-_•- (,/' _-------_-_--__- (Complete in Duplicate) *2.4-Y) '�[' 10 Date Issued ____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION-----�ga------ ------------------------------------------------•--------- C-.-�---�-- Owner's Name .eN- •--------- --------------------------------------- Phone// Address !'� ---------------------•-------------------------------------------------------------------------------------- -------- ------ ..Q... Contractor's Name--------- �. .,___��eco, --_.��G'•- Phone -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f' Number of living units: _ _- Number of bedrooms__ Number of baths _,�-_ Lot size ...A. -_---_--___07 X-. ------- Water Supply: Public system [Community system, ❑ Private ❑ Depth to Water Table '6U ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ,Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e__'I'-ardpan ❑ Previous Application Made: (If yes,date--------------------) No �ew Construction: Yes ❑ No Zk/fHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubic sewer is available within 200 feet.) SepticTank:_ Distance from nearest well------- -..._Distance from foundation-------------------.Material------------------------------------------------- ❑ No. of compartments--------------------------Size----------.-----------------__Liquid depth--------------------------Capacity----------------- / Disposal Field Distance from nearest well,�X/&bistance from foundation..../1'0.0___-Distance to nearest lot line___S------ ��I�� Number of lines_--.__--_ Length of each line__-__-.__-,`SP1_- ------Width of trench........... �_-_-----_-- __ JJ,p ------------ Type of filter material -----Depth of filter material_-_--.�___.__-_--Total length_.___________________•____-...___-__.-_-- / r � Seepage Pit Distance to nearest well_IVO-IVOfrom foundation----- _._-_.Distance to nearest lot line_-- a Number of pits___-{--_-_-_--_-Lining materiaL�QC7,C_Size: Diameter-_--0_3__.....Depth-------------- --------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------•----------------------------Depth--------------------------------------------------Liquid Capacity------------------------- .gals. Privy: Distance from nearest well-____-_----------------- ------------_----_Distance from nearest building-------------------------------------- ❑ 4stance to nearest lot line-------------------- ---•-------------------------------------------- Remodeling and/or repairing (describe)----------------- ---------X!------- ----------- �-----------------------------•--------------------- ------------ 1 �� - --------------- ------:---------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 the San Joaquin Local Health District. Ow rand or C ntracfor (Signed) ----- By:_ ------------------------------------------(Title)------------ (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ------------ -------------------------------- DATE -------- --F'�.:.I,----------------------------- REVIEWEDBY------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------=-- ------------- --------------- 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 9th Street Stockton,California Lodi,_California Manteca,California Tracy,California Es 9 REVISED B-59 3M 3-'63 F.P.CC.