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F TFICE USE:---------------------------� -----------------_------------------------..------------- APPLICATION F'dR SANITATION PERMIT Permit No. ....... (Complete to Duplicate) ------------------- ---------------- --------------------- - - --- --------- This Permit Expires 1 Year From Date Issued Date Issued i 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 LOC TION__ ------ ---------------------------------------------- Owner's Name------ - ---------------------•----•----------•----------- --------------------------------- ---... Phone.---------------------------------- -- Address Address ----------- ..... - � /Q Contractor's Name----------&'I`.. `�%{/ /�� ------- -----------••-----------------------------•-•-•- ------------------------- --. Phone.............................. Installation will serve: Residence 91--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: _/--- Number of bedrooms . _ Number of baths _1... Lot sizelQ/ --,-- -------------------------------- Wafer __-_____-_ _-Water Supply: Public system ❑'mmunity system [] Private ❑ Depth to Water Table % t. Character of soil to a depth of 3 feet: Sand ❑ Gravel-E]; Sandy Ldzim,❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ : Yes❑ No FHA VAYes NoPrevious Application Made: llt es,date----------- � No V" l`w-Constructon ®� TYPE.OF'INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ° Septic Ta k: Distance from nearest well____ =____,Distance from m foundation_f,Z--__---_.Mat jl__.�i �i -___--__- No. of compartments--- - --------------Size._F�� .___--__Li Liquid de ih__ ._. ....... ' Q P. � Capacity-P Disposal field: Distance from nearest well....._--_.-___ _.Distance from foundatGion-A�___......Distance to nearest lot line___....._ Number of lines....... ...... ... ...... Length of each line_--{�� Width of trench.. ._._..._._ f � r V' Type of filter material __ __Depth of filter material__ .___-_._.Total length_._.. ............................... :+W^ 1 i "-1 FI - , V, Seepag it: Distance to nearest-well_________ _________Distance fr fo ndation___./s�_.-..__-.�jis ante to nearest lot line_1,e...... Number of pits_..-. ------------Lining material--- 'S _*_ - Size: Diameters _ ----------------- ❑ Size: Diameter---------.----------; Depth ------------------------- Lining material Cesspool: Distnce from nearest well.................Distance from foundation--------------------Lu'd Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from.nearest building...._._._______..._._..____-__....._.__. ;- ❑ Distance to nearest lot line----- -- ---------------------------------- --- t ------ 'C Remodeling and/or repairing (describe) = /1l )- ----- gyp, ------------ ---- ------ ___Y -,_ �.�. ; ...__..__k_________________________________________________ _- I s r _ ________________________________________________________________________________________________________________________________________________________________ ____________________________________________________ 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 rN ions of the San Joaquin Local Health District. i (Signed) ---- - - e---�-(f/ ----- ,...�„b..�/or Contractor) ------ - ntra 1 BY: ----------- --------------------(Title} �� (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------Q.. ----- -----------------•---------------- DATE------ REVIEWEDBY ----------- -------------------------------------- DATE--------- --------- BUILDING PERMIT ISSUED------------------------------------- ----------- DATE. �~ Alterations and/or recommendations:--------------- - ---- ---------------=---------------- ----------------------------------5_-_--_._...--____._-...--.-_-.___-_____--..-.--.--________-.-.---_-.-.--_-_-___._._.-----___._-_-.---.----._.------._._..._______------_.__._._.----.---.- ------------------------------------.------------------------.---'----------------------------..._.....---------------------------------------------------------------._.._...------------._._..----"-._._.....------------...._..__. FINAL INSPECTION BY:....C.........�r------------- ------------ Date- ,Zc� SAN JOAQUIN LOCAL HEALTH DISTRICT c-1 tiQ1-E Haielfon a: Avd- -- — s � '> 300 West Oak 5lreet 1,24 sycamore'Street, 205 West 9th Street Stockton,California Lodi,California Manteca,Californias r'�r Tracy,California 'ES 9 REVISED B-59 3M 3-'63 F.P.CD.