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FOR OFFICE U : // T `Z' 3r Permit No. f.�.7 Q.. APPLICATION FOR SANITATION PERMIT ______----------_____ ----_------ (Complete in Duplicate) Date Issued ... ------------------------------ ------ __________________ 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 LOCATION___-_ 1_=1_�` __-- - ---------- ------ -- Owner's Name_. X�..... --------------------------------------------------------- Phone------------------------------------ ------•- Address------ ---�- / - ----- ------------------------------------.....................................----- Contractor's Name---------- - Phone___________________________________ Installation will serve: Residence Ur'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑.O`he510- /-- % - ss�� Number of living units: __/-__ Number of bedrooms _-N Number of baths __-l__ Lot size Q•. - ----- ------ Ll q Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe 0,-Hardpan ❑ Previous Application Made: (If yes,date-----------:--------) No 22-' New Construction: Yes ❑ No [Er'-FHA/VA: Yes ❑ No E4-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic dank: r Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- /11� No. of compartments--------------------------Size----------------------------•---Liquid depth--------------------------Capacity-------------- Distance from foundation tante to nearest lot line_��__-.......... DisposalFiejd: Distance from nearest well_--_---_ r idth of trench- - Len Length of each lirr - ------------------ OW/ -� -- / `4 Number of lines-------- - i g �l Type of filter material, Depth of filter material-�-�}-__--__--Total length--------- ----' ------ Seepage t: Distance to nearest well_--------•_-------_Distance fr m ff undation-_3 ..__-.Di tante to nearest lot line-t - /. Number of pits-__-1._f Ste- fining material.__ GN-----Size: Diameter ' ��_--------_-De 1th.� 23 -�-------------- s ------------ e sspool: Distance from nearest well-----------------Distance from foundation material,-- gals. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Liquid CapacitYi----- ------------- privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ - ---•----------------- Distance to nearest lot line------------------------- - ---------------I...... ----------------------------------- - ----------- ------ J ------------------------------------------------------- Remodeling and/or repairing (describe)%---------------- --- -- -------- ----------------------------------- ------------ -------------------------------------------------------------------------------------------- - - San -o -un - - 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, a rules and regulations of the San Joaquin Local Health District. --- -------- :.Calor Contractor) (Signed)_ - --- ---- ------------- ---------------------------------------------------- - BY: rtle / iL -- - -------------------------- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =l - DATE ;1!}f � REVIEWEDBY----------------------------------------------------- - -------- ---------- -------------------------------- DATE-------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------- ----- - DATE. Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ------------------------------------------- FINALINSPECTION BY----------------= ----------------------------------.' Date-------------- 7 ----------------------------- 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 8-59 F.P.CD.2M 6.60