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FOR OFFICE USE: ---------------------------------- ----------------- - ----------------------------- ------ -------- ---------- �`141J�ICATION FOR SANITATION PERMIT Permit No. ........ -------- ------------------------------------------ (Complete in Duplicate) 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 her descr This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... Owner's Name-------- 1- ----&------- ----------------------------------------------------- ------------------------------------------ Phone-410 .. .............6 Address. X jty Aw...At......... ---- -------------------------------------- Contractor's Name.........> ML?l7................................ --------------------------------- --------------------------------............ Phone................................... Installation will serve: Resident F] Apartment House ❑ Commercial E] Trailer Q§V+ �otel [] Other Number of living units: ---- Number of bedroomsZ�. umber of baths -1.... Lot size ----- ---------------------------------------------- Water Supply: Public system Ej Community sy t 9 Private E] Depth to Water Table/ ft. W19a WO To FZ Character of soil to a depth of 3 feet: Sand Gravel 0 --Sandy Loam E] Clay Lo Q__-Adobe_0 __Hardpan,Zj Previous Application Made: (If yes,date------- ------------) No N New Construction: Yes No ❑ FHA/VA: Yes El No�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) PRF__Poo,L-5 S e P tj c n_k: Distance from nearest well...5 57 0__Distancefrom foundation----- M te�* I C-70 C7PF�J-,JE ---------- No. of compartments------- -------------- �T depth---- —. ----Capacity..... Disposal Fi Distance from nearest well-- 47 0...Distance from foundation /42 Distance to nearest lot line.... Number of lines. line______. V.............Width of trench-------_:.2Y.line_ -------- -Length of each --------------- Type of filter material... --Depth of filter material------ Total length___....._. ---------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot Number of pits-_ line----------------- V 171 --------------------Lining material------------------------Size: Diameter____-_____-_.____._____Depth_.-___.__..__-_-----____...___--_ 11 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-.-.__--_._..______.________---00 El Size: Diameter------------------------- -----------Depth----------------------------------------------------Liquid Capacity-------------------.------gals. 0 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-____________-________-___.____.__.__-. ❑ uilding------------------------------------------ F-1 Distance to nearest lot line----------------------------- Remodeling and/or repairing (describe):---IN4-7-,4.A 77410IN----?V1.4_4r---Aftil-E----- Vawe_.. 'Epp-----A$ P....... ------ ro --------W.14j� ------------------------------------- --------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulations of the San Joaquin Local Health District. (Signed)---------)-?------; ------ (Owner and/or Contractor) By:--------------------------------110- ----------------------------------------------------------------------------------------------------------------- --------------------------------- -----------------------------------------------------------------(Title)---------- ------------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------------------------------------------------------------- DATE-------- REVIEWED BY--------------------------------------- ------ DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- --------- DATE------- Alterations and/or recommendations----------------------------- ---------------_------------------.............. -------------------------I------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------............................ ------------------------------------------------------ ------------- --------------------------- ------------------------------------------------------------------------------------------------I----------------_-------- ----------------------------------------I------------- ...... ------------ ----- -- -- ---- ------------- ------------- -------------------------------------------------------------------- -----------------------------I-------- ------- --------- ---------------_ ..... ----- - ---------------------------------------------------- ---------------------------------------------------------------- FINAL INSPECTI - -- ---- - - - ------- -----P_ _ Date----- ---------7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 199 9 REVISED 8-59