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�'� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby q r This application is made in compliance with County Ordinance No, 549, JOB ADDRESS AND LOCATION_______________ _ .7--------- -------- ---------------------------------------------------------------- ��C [.[.' /lrL ----- Phone-- Owner's Name-------------------- ------------ -- - ---- -- --------------- z3� --- ----= ' ."` ..�""e�`-----•-------------------- ----------••----------------------------------- Address----------------• ------- F ---------•-- Phone----------------------------------- Contractor's Name--------------------------- - -•--•---------- ------------------- Installation will serve: Residence ❑ (Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other [I Number of living units: __-__.__ Number of bedrooms -----._ Number of baths -------- Lot size ------------------------------_----------------------------- Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Table ''-1rft• i Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes F] "No 9 New Construction: Yes ❑ No FHA/VA: Yes ❑ No a I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: Distance from nearest well_________________Distance from foundation-------------------Material_________----__.---_---------------------------- jt (,5 }'// . of compartments---- ------------- Size Liquid depth Capacity 'L __-__Distance to nearest lot line------- Disposal Field: Distance from nearest well-.-. ^---_-.Distance from foundation_._-__. __ Number of lines`- --------------�/-----�--�-----_--Length of each line________-�-gp-d----------Width of trench---_------------------------------- Depth of filter material___1,7-"/ ----Total length------------- ---------------- p ' Type of filter material------4f-F r " P 1^' 1• A , 1 Seepage Pit: �� Distance to nearest well------------ from foundation-------------------- to nearest lot line----------------- CA❑ Number of pits--- ------Lining material----- -------Size: Diameter---- Depth Cess ool: Distance` from nearest well-----------------Distance from foundation____________________Lining material-_._____--_______.-___._-_____ .___. P 1 -----------------------------------------------------Liquid Capacity----•---------------------- als. ❑ ---------=---- --- Depth9 Size: Diame1. 11 i Distance from nearest buildingI Privy: Distance from nearest well----------------- ------------- r ❑ Distance to nearest lot line---------------------- -- --------------•-----'------ - { ' r ------- ----------- --- - --------- or repairing.(describe): --------`�'�' �`-- - ----- ----- Remodeling and/ P 9 { 7 } , �----•• --- - ` - " ,�- - _w 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. R % and/or Contractor ' � - ------------------- I ----- ----- ---- -��---------- --------- -�------- -------- ----------- -------Owner a / (Signed)--------------------------------------------------------------------- -------------------------------------(Title------------ ----------------- --------- ---- ----------- ------ By:------------------- - - ) (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 ; I APPLICATION ACCEPTED BY--------------- -------- '-------------------------------------------------- DATE---------------------------------�; - - - ---------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------t. DATE i ___ DA � REVIEWED BY_ ------�--- ----- --- -�----.i-• - --- tr --------- --------------- ------------------------------------------ Alterations and/or re ommendations:____-------------------- el -------------- - ----- R'lJ��=-` �W�---� -T ----- �F"f- _�--------- -- - ' �` , FINAL INSPECTION BY: 'r. . ..... •---- Date h SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 4. 814 North;"C" Street 130 South American $orae+ 300 West Oak Street y i Lodi, California Manteca, California Tracy, 4;aBfornia Stockton, California } FS-9-2M Revised &'59 F,P.Co. j . ".: �_..✓.moi-..� - � � � � - ._ --- -