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FOR OFFICE USE: -------------- - ---------------- ------I------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ --- --------------------------- (Complete in Duplicate) fi Date Issued ..... --------------------------------------------------------- This Permit Expires I 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 applica, * * d _�,Z�n co;�Iia wit ty Ordinance No. 549. CAT N W. JOB ADDRESS ALNDLO&T ....... .... Owner's Name...... ............... . .... .. - ------------------- ------------------------------------------------------ Phone................................. Address ----------------------—----------------------------------—--------7---------- -------- 7- Contractor's Name---------- ------------------------------------------------------------------------------------------------".Ph%e..................................... Installation will serve: Residence Apartment House E] Commercial F1 Trailer Court F MQfel E3 -Other [] .......................... Number of living units: ./---- Number of bedrooms-$ Number of baths /w.N.- Lot size ... Water Supply: Public system 171 Community system E] Private,y Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loa' ih F Clay Loom [] Clay❑ Adobe, Hari-pan 0 Previous Application Made: (If yes,date---------_--------) No New Construction: YesZ No E] FHA/VA: Yes ❑ No;K] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance froip nearest well.,S_&L----Distan5e,fr9m foundation..Zo...........Materol---- ........... ---------- No. of compartments-------?--------_-----SiZ6-3-x�-&X.A... Liquid depth_____--S----------_------ Disposal Field: Distance from nearest ----Distance from foundation../O...........Distance to nearest lot line Number of lines----?----------------------------Length of each line IP 0/ .....Width of'trench. . -R Y?� - -- -- ----------;P1 -------I....... ................ Type of filter material epth of filter material ---------Total length_--... ------ Seepage ... Seepage Pit: Distance to nearest well _____________________Distance from foundation....................Distance to nearest lot line:.__ ..... 1_1 Number of pits______ __________ ___Lining material-----------------------Size: Diameter-----_--------------_Depth-------------;;------------------ Cesspool: Distance from nearest well_____________ ___Distance from foundation__-___ .Lining material,....................-............... 171 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):-- --- ---------------------------------•--------•-----•---------•------•----------•--------------- •------_. ....:.. ...r...... ....................................................................................................................................... --------------------- ............................................................ ---------------------------------------------------------*--------------------**----------------------------------------------------------------...................................... 7------------------------------------ ------------------------------------------------ --------------------------------.........................................................—•---......•-•-------•-=•----.............. ..................................... I hereby certify that I have prepared this application and that the work will be done in accordance: y with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- - - - -- ------------ ------------- --------------------------------- ------------------------------------------------- ----------------------(Owner widyce. eonfrwcfor�- 01 --- ------------ --------?-L-_ 4- By:............................................................------------------------- ---------------------------------------------(rifle)---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O APPLICATION ACCEPTED BY.--C—C------- s?- ------ !./,/-------------------... DATE.......:;�1_74�Z...........----------- REVIEWED BY -------------------------------------------................................................... DATE................................. --------------_--------------- BUILDINGPERMIT ISSUED................................................................................. .................. DATE............................................................ Alterations and/or re mendationis:---------------------- -------------.......ZZ6-------- ............ . .... ... -- ----------- ....... ----------- Com -- . . ... ... ------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ------------------------- -------------------------------- ....... ----------------------------------------------------------------------------------------------------------- ................................................................ NAL INSPECTION BY----------------------•----------------------- ....... ...... Date._.. SAN ate----SAN JOAQUIN LOCAL HEALTH DISTRICT 10 South Am4.rican Street 300 West Oak Street 124 Sycamore Stilet 205 West 9th Street Stockton,C Ifornia Lodi,California Manteca,California Tracy,California fornia 2M 6-60