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�R OFFICE USE: f `I - `- Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued tt__-___._--._. This Permit Expires 1 Year From Date Issued pplication is hereby made to the San Joaquin Local Health District for a permit to con truct and install the work herein described. (his application is made in compliance with County Ordinance o. 549.,�6 ---�I ----------- 1� ----- JOB ADDRES f-----. Owner's Name_ �n' ll�/- ----- -- -------------------------------- Ph Address----- C-R- ---- - �,t,� ------•----- Phone.__ --- - _. Contractor's Name__ -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rooms !�Number of baths �"_ Lot size Number of living units: -1-___ Number of bed .._ r ----- ---- Water Supply: Public system ❑ Community system ❑ Privateep th to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe and an ❑ Previous Application Made: (If yes,date---_--_----_---.-) No ❑ New Construction: Yes ❑ No�FHA/ Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if publ��wer is available within 200 feet.) Distanc from f un n__.20-------_Mater', I_____.-�"-=-=----------�-- Septic Tank: Distance from nearest w�ell ____.- / t"-_"_-Capacity__._ �. SizeI'l /y 0f., No. of compartments__ _.___- 1�-- x-- -----Liquid depth__ -------- / - n� /- Distance from foundation-___-"lV---____-Distance to nearest lot line--___C� ------ Disp al Field: Distance from nearest well - // Length of each line______ _-pf------------Width of trench__-t- ---------- ------- Number of lines------ ----- - g -e--------------- ___De th of filter materia.__..__��--------Total length_________________ � Type of filter material __ - - p �'` t well _ --__Distance m f undation___ - Distant to nearest lot line__._/Q+_____-- Seepage Pit: Distance to Weare De th___G .� wj Number of pits- L' material_____ -Size: Diameter_ ---j- P t' Cesspool: Distance from nearest well_________________Distance from ounclation--------------------Lining material.__.-_._.-___._.-____________________ ____--_Li uid Ca acit ----------------- ------❑ Size: Diameter------------------------------------Depth-------------------------------------------- -------- --- ----------------Depth-------------------------------------------- q P Y-------------- Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building------------------------------------------ t ❑ Distance to nearest lot line-- ------------------------------------------- ---------------------------------------- ------------------------------------ ` Remodeling and/or repairing (describe= - i f `-- - ---------------- --------------"----------------------------------- - - ----------------------- ---------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- I hereby c rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e s, ruleja; regulations of the S Jo um ocal Health District. -_ _-_ _ __ip�s{(aed,L,or�Contractor) Si ned ---- JPTitleBY: -- - --- --------------------------------------------- (Plot plan, showing size of lot, location of system in relation to ells, buil ings, C. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---C._.- DATE_. - REVIEWED BY - - - ------------------------------------------- DATE------------------------- ------------------------------- DATE ----- .. BUILDINGPERMIT ISSUED--------------•-----------------------------------------------;------------------ Alterations ---------- , Alterations and/or recommendations:---g..---77--0— 1 -----�x1� `� -------------------------- -------- ---- -------------------------------- �--------- - ------------- - FINAL INSPECTION BY---------- - =--- ---- -- ------ ----------------------- Date------------- --SAN JOAQUIN LOCAL HEALTH DISTRIC 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.CD.