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OFFICE USE: f- //33 /a / -----------.�-------- APPLICATION FOR SANITATION PERMIT _ Permit No. -------------------"'� .- _ (Compete n Duplicate)--- - liDlitDate Asued ... 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. JOB ADDRESS AND CATI N_....__..... -- - - - - -- - ---/---------------------------- Owner's Name ------ - Phone.._��..S ... -_7_ Address---------- � �.. --k `� . ---•-------•--••--•-----------------•-----•---------------------------------------- -------------- - Contractor's,: Name---- u✓lf,--•---------•--- ----- Phone Installation will serve: Residence ®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_- Number of bedrooms .3-__ Number of baths -_-1_-- Lot size •---��_�_x--�_s�,�- .-. -/ Water Supply: Public system Community system ❑ Private ❑7,Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej--1=lardpan ❑ Previous Application Made: (If yes,date--------------------) No 5"' New Construction: Yes EY"'No ❑ FHA/VA: Yes ❑ No [9'_ TYPE OF INSf-ALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic�T Distance from nearest well-r1�9>T ..--Distance from foundation----- _ ---------Material. ---------------- --------------- No. of compartments............ZZ---.___size....''�x �'_�--._..Liquid depth------'�--�____._--_Capacity...._- Disposal /�� Field: Distance from nearest w I-_ -Distance from found tion..-.-_ 6-.r___.DistaUe to—nearest lot line... ©/ Number of lines------------------------- ------ -Length of each line.._t7'3o_ C.'ev`t�t5h"o�1'trench--__-.--.. ! - ------------ ---- ----_--_-..T e of filter materia . --.�_�dt��Depth of filter.material-_--.1.d'_ ___...Total length_._ YPIV Seep g it: Dist ce t Weare well _.- _ Y: -_ istan frW- e D' any one est I lin .._ N ber pit in m ial er --- ----- ------ 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-__.__--__-._-._.--__.---_--------._.._. ❑ Distance to nearest lot line--- -------------------------------------------------------------- -------------------------------------------------•-------------------- Remodeling and/or repairing (describe):----------------------------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- �'f --------------------------------------------------------------------- -------- -- .Y I hereby certify that I have prepared this plication and he work will be done in accordance with San Joaquin County ordinances, Stat law a rules and regulati s of f1fe San uin Local Health District. (Signed) ---- ---- ------ --------------------------------------------------------------------(Owner and/or Contractor) Title (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 04 FOR DEPARTMENT USE ONLY ~ --- DATE..... --- ------------------- ,)_ r� APPLICATION ACCEPTED BY...-_-_._.--<..--_�.C�--------------------------- ------------------------------------ REVIEWEDBY------_------------_-------------- ------- DATE_------------------------- --------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- ------ DATE--------------------------------------------------------------------------- - Alterationsafid/,Ar recomme dations--------------.-------------------------------------------------•--._ -- ---------------------------�P -- ----------------------------------- ----- ---------------------- ------------------------------- --------------- ------------------------------..-------------------------- FINALINSPECTION BY:.-----..6� --------------------------------- Date---- e �-------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazolton 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.CO. Y-