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--} APPLICATION FOR SANITATION PERMIT Permit No. _ _. ..._.._. ' .•\.A (Complete,in�,.Duplicate) . �� _ .,. ., -- ------ -- -------- This Permit i:x fires 1'Year From Date Issued Date Issued::_._.... .� ". Application is hereby made to the San Joaquin Local Healfh D,is`tric#for a permit to construct and install the wor'lk herein described. This application is made In compliance with County Ordinance No. 549. I JOB ADDRESS AND LO ION....___ . r ' .. .._ -:. Owner'sName .. ----- ..__"Phone---.. .- x Address----------.......... • Contractor's Name --.......... Phona..� fP.b+ `f- r Installation will serve: .Residence Apartment House Commercial o ` p ❑ [Qj''Trailer Court❑ Motel ❑ Other-0 �. Number of living units- _/_. Number of bedrooms _1<Nunrmber.of-baths _/... Lot size _._.. _ _ ' _ _ �x. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3'feet: Sand Gravel p ❑ ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date____________________) No ❑ New Construction: Yes ❑ Nom ' FHA/VA: Yes ❑ = .Nn 0 _ TYPE OF INSTALLATION AND SPECIFICATIONS- [No septic tank or cesspool permitted if pu lic sewer is available within 200 fe t.) f� ----- _--- Septic Tank Distance from nearest well _Q__ . Distance from faun la _ a!__w_ .Material____ ___ _____. _._ No. of compartments..___.. �Sizel L�.�. i�uid de th__ i!" ;...Capacityov, Disposal Field: Distance from nea t well- 47V.._"_...Distance from founrfation�Q_._.-----�Distance to nearest lot line.' - Number of lines._`..__.__.------ . Length of each line,�t'_e4?_f{�' /idth of french----------- - ........--1 Type of filter material_ Depth"of filter material__ . !7......__Total length.__ &0.1: _....._.__ Seepage Pit: : Dista rice to nearest well-.--------------m'-------- Disfance;from foundation......._._ .........Distbnca ta-Wastes# lot line `J ❑ Number of pits-----------------------Lining material Size: Diameter__" ------------------Depth-------------- _ Cesspool: Distance from nearest well--------------.-Distance from foundation--------------------Lining material------------------_______ ❑ Size: Diameter Depth -- -yi£ A. =----------------------------------Liquid Capacity---------------------- 9als. - b, 1. - Privy: Distance.from nearest well---------•--._.. """"-=----------------- ------Distance from nearest building----•--"--------------_--•-,-•---------•� ❑ Distance to nearest lot line------------------`-_-------------- ---.------ - -,..... -- Rem odiyiing and/or repairing (describe): P t ----- •------•---•----- ... . •----- nU rc ---------- .-•-- • -- I 'hereby certify 4hat I have prepared this application and that the work wt I be does in accordance witli.5an Joaquin'County Y`, ordinances State 1E. s;;and rul s and regulatio of the Barr Joa n Local He th District. - [Signed) . ............R1... Contractorntle ) . ...^ )-- (Plot plan..showing size_of lot, location of system in relation eHs�-buili ings,°e can be,placed on reverse,side). FOIL DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. 5 _ :--•---------------------- ----------- DATE----------------•------------ = = -•- . . REVIEWED BY ---------•-------=---------- ------ -`--------•-•--- =------------- DATE.-------------- r BUILDING PERMITISSUED-------------------------------- -------------------------------------- •-------_..------ DATE-------._-..----------- ------------------------ Altera# ions and,4or recommendations: --- ----------------------- - - -- :.. .. .. . _ op ------------ ............................ ................................................. • •......... ------- -------------------------•----- i r FINAL INSPECTION BY:. ......, `�ryill . Dote ------------------------------------ SAN ---- •---------------------------SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 E.Mazatlan Ave. 300 West Oak Sireef 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California C5 9 REVISED 8-59 3M 3•'63 F.P.CO.