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FOR OFFICE USE: - _ : APPLICATION i�OR SANITATION PERMIT � �- - Permit No. ... -•-- �f 5 ---------- k �Sy 4 (Complete in Duplicate) Date,Issued .---�-��--- - 6 This Permit Expires I..Year From'Date Issued ___-.__-------------- r : Application is hereby made to the'San Joaquin Local Healfh District for a permit to construct and'install the work herein described. This application is made in compliance!'with County OrdAe No. 549. ' JOB ADDRESS AND LOCATION _____ ----------------------------- ------------ -- --: . ----------- -------------�---- - Phone. - 7 Owners Name-------------�--- �---------- - •-- -- - ----- - - ---------------------- --- -- ---- �. Address------------• -j--- --- - - ------------------------ ------ -----------------------------------------------------••- Contractor's Name------------------------------------------------ --- -- - ---------------- Phon ��t -� -7 Installation will se ve: Residence )( Apartment House ❑ Commercial j] Trailer Court ❑ Motel ❑ Other ❑ Number of-living units: 1 h Number of bedrooms .CA- Number of baths -__ Lot size .____ ____. _ a-- ---- as----- ----------------- � Water .Supply: Public system Community system ❑ Private ❑ Depth to Water Table S4 ft. Character of soil to a depth hof 3 f6dt:' S-ancl ❑ Gravel ❑ Sandy Loam ❑ Clay Loam;❑ Clay ❑ A`dobex Hardpan ❑ Previous Application Made: (If,yes,dafe/Y T.----) IN ❑ New Construction: Yes ❑ N8X FHA/VA-Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) r h ar&: Distance from. nearest well________________Distance from foundation__._-___`____.____Material-----^___'_____---________________-_ _---___._. No1of compartments---- --------------------Size------------- -----------a-----Liquid dep:th------------- ----------Capacity----------------------- OF*, ---------- ------ Id. Distance from nearest wel?.Distance from foundation.-�---___.Distance to nearest lot line Number of lines'-J-/ Length of each line___ _Q_�_____ _____.Width of trench.._._AR!_y._________�.__.._ Type.of-filter material_•__+_ _ __.Depth of filter material__-IS-____-----_-Total �lerlgth__'____---_�_____:_____O�_�_______._ J ---- : Distance to nearest well--- from f undation-_,�_5`�.___.Distanceto nearest,lot line___,?-,_.__ Number of pits____--------- --Lining material _-:Size: Diameter__&_:------_._.Depth___._.,0_S7 60 _-. 60 Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining materiaL.__..____.__-_---_._______---------- 0 ❑ .I w..-- ----------------------Li Liquid Capacity --- gals. Size: Diameter----�----------- ------------#-Dept------------------------ - - q p tY-,---- - - ------------- Privy: Distance from nearest weli______.._____ _____-_= ______________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------------- - --.-- ---------------------------------------------------- ---------------- O Remodeling' and/or repairing (describe) ------- -------------------------------------------- --------------------------..:---------------------------------------- I ---------=----------------- -----------------------------------------------------------------------------------------•----------------------------- - --------------------------------------------------------------------------•----------------•----------------------------------- . .f , ---------------------------- �.: I hereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin County ordinances, State 11a)j nd rules.aetd(regulations of the San Joaquin Local Health District. . 4 (Signed) -------=.-• ----- -------------- ---------- weer and/or Contractor) -- (Title) By----------------------------------- = - ._.... (Plot plan, showing size of lot, location of system in relation to wells,:b gs, a+c:,- can.l a Lplaced=on reverse"side). .� -—FOR DEPARTMENT USE ONLY, -�—•' APPLICATION ACCEPTED BY---------------- -- ... -------- ----'------------------------- ------------------ DATE--- fG—� REVIEWEDBY---r-------------------------------- ----------- - -------------------#-------------------------------------`-i- DATE------------- = BUILDING PERMIT ISSUED _ a--- -------- - - DATE = ---------------------at` ns:' ------------------- Alteration and/or recomme • ----- -----h---- _ "'o } ----------------------a---=----------------=----------------=---- --------- ---------- -------------------- --------- Ik. ------ -----------------------.-.-...-.I.---------------------.-1----- -- a.._.._.-� --^-----------•-----------------------------•-'---`------=-------------------------------`---------•------------_ —----- ----------------'- , 1 . ae FINAL INSPECTION BY:---------F__' -Ca ------------------- ------------ Date-------- l—` ---`--rte-- ------------- ----- ._ . 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 ES 9 REVISED 8-59 3M 3-'63 F,RCD. - t