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FOR OFRCVis�' / _ " ��"� APPLICATION FOR SANITATION PERMIT Permit No. ../.• ..---- -- - _____. (Complete in Duplicate) ----- ----- ---------------------- _1Date issued ... _--_- This Kermit Expires 1 Year From Date' ssue Application is hereby made to the Sen Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. j ---------^` ---------••---"------•-"-- JOB ADDRESS AN L ATION. -----�•------. -- .-.� :--_-•---- ---•�-�.,�'-!,.� -- ----------•----- Owner's Name------ Address ---- 1 f�� i 'X -----. Phone. .... - Phone- ---•------•------------------•---- Address •• --------- - G Contractor's Name--------------------- -------- •----- a --- --- ------ .... Installation will serve: Residence Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r ri Number of living units: ____/: Number of bedrooms _ Number of b __:_.-__ Lot size --> ..----. ••- Water Supply: Public system ❑ Community system ❑ '•Privates epth to Water TableQ. ft. •`" Adobe Hardpan Character of soil to a depth of 3 feet: (Sand ❑ Gravel ❑ Sandy am ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made: (If yes,date-----------_---_----) No ew Construction: Yes ❑ No. A/VA: Yes [I No M---" r TYPE OF INSTALLATION AND SPECIFICATIONS: -11 (No septic tank or cesspool permi#ted if public sewer is available'within 200 feet.) Septic Tank: e .Distance from nearest well-------------------Distance from foundation--------------------Material-------------------------------------.---____-.-. No:.of compartments= Size---------------------=----------Liquid depth--------------------------Capacity--•-----------••----... �Isp�,:o,a jFii, _ / : Distance from nearest well.��'------.-Distance from foundation.-,/�.-----------Distance to nearest lot kine________________ Len th of each line_ ".__ __0__f Width of trench_._-4P__ .��_________________ } nber of lines - -- ------I--- ----------- 9 I----- .s.�. C 4 K------De Depth of filter material---I-t�_--------------- Total length-----��------__---------------•-- ,4Co 4� Type of filter materia -- -- -- p u / Seepag ': Distance to nearest w II__ _.___.__-Distance from foundation_Z_O-----------Distance to nearest lot Number of pits"__-_`_ ---"-"_--Lining material_�e_o_r4`_____Size: Diameter. ? ___-______.Depth_. .-n --------- Cesspool: Distance from nearest well______-----------Distance from foundation-------------------Lining material___-._._____--_____--_________-._____. ❑ Size: Diameter--------------------------------------Depth-------•---------------------------------------:----Liquid Capacity ----------------------.---gals. Privy: Distance from l nearest lime .-_ -------------------------------------- istance from nearest building------------------------------------------ Privy: :__--__--_r------------ --- - ` I ❑ Distance to nearest ;A - _ ___ __----•------ Remodeling and/or repairing (describe)_____________________ � `� � �' ---------------------------------------"-----------------,-------------•-----•----------: .. ---- ------ -- --------------"---._ .-----------------------------•-------------------------- ----------- -------------------------------------------- i l -----•------------ ---•-----•---------------------------------------------------------•---------I----------- 1 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 regul is-of he,, Joaquin Local Heath District. Ir I r ' r -------- ------------------------------(Owner and/or Contractor) ,(Signed) -- is - --- ------------- ----- ,� r Title By: - ----- .� (Plot pian, showing size a o , locate of system to relation to wells!buildin , can be placed on reverse side). ]FOR DEPARTMENT USE ONLY ) _�- ��Y��_� ---------------------- DATE------ APPLlCATlON ACCEPTED BY -------- =' �; ! � f f BY--------- --------------- ------ -�---- ---------- ---------------------------'-•---------------- ----------------------- DATE ----------------------------------------------------- REVIEWEDBUlLDING PERMIT ISSUED--------—-------'--•-------- ------------ --------------•------------- ---- -------------. -- D TE ------------ Alterations and/or recommendations:-/,� �'✓1..-. O- / = �` - �`.. - ---- - --------•------- ------------------------------------------------------•------ -------------•------------------------------------------------------------------------- ---------'- --------------------------- _________________________________________________ _ 4 ----------------------------_---------------- = :: ' FINAC-INSPECTION' BYs . ' �'"'"''�— Date" - ' r SAN JOAQUIN LOCAL HEALTH DISTRICT f `, 124 Sycamora Street 205 West 9th Street j 13D South American Street- ) + � 300 West Oak Street) l , L h I - Stockton,California Lodi,California \ Manteca,California Tracy,California EB-9 AEYI9 Eo 8-59 r.P.c O.AM&-do -