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FOR OFFICE QSf_: R________ _ ______[ �.�_-t ---- APPLICATION" FOR SANITATION PERMIT Permit No. ------------- - - �'�"-�"'E 1- �y p-`- (Complete in Duplicate)- i � p A } .. ... Date Issued -----�`-f�/�� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ord'nan No 49. JOBADDRESS AND C6ATION- ---=--------------•-----------•----- -----------.-------------------------------------------------- Owner's Name � r' - -------------- Phone---------------------------------- Address_ . 4&0 � -- - ------------------- •------•-•---- Contractor's. Name---------- - - Phone---------------•---------•--------- ----- --- - -- installation will serve: ResidenceApartment House E] Commercial ❑ Trailer Court E] Motel E] Other L3Number of living units: _. Number of bedrooms _A_ Number of baths __/__ Lot size _�p�� Yjl--- ________________________ Water Supply: Public system RIO-5ommunity system ❑ Private ❑ Depth to Water Table 45:�_rf. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Z?-"F`l`ardpan p Previous Application Made: {1f yes,date---_---------------} No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Tank: Distance from nearest well_________________Distance from foundation-------------------Material----------------.---------------------- ---------- 6111* No. of compartments--------------------- ----Size----------------------------:_.-Liquid depth--------------------------Capacity----------------------- 1 Di�osaP Field: Distance from nearest well........ -'__ .Distance from foundation__liP9_...........Distance to nearest lot line.-I .._ ..__. '.I 4P•�� Number of lines--------- - -- --- 00 Length of each line_ !�17�___. Width of trench_ _,-__._______..____.__ Type.of filter material of filter material___f _______.Total length___., �___________________________ {'� Seepage Pit: Distance to nearest well......'�--- --_-_Distance fr fo ndation___Z ..___.Distance to nearest lot line____-.. Number of pits.t_ -__._____=--Lining materia Size: Diameter_ --__Depth✓ ,1 _____ Cesspool: Distance from nearest 'Well-----------------Distance from foundation-------------------:Lining material--._-___....__.-_-_-_-_________- ❑ Size: Diameter--------------------------------------De th-----------*----- ---------------------------- --Liquid Capacity, -- - --- 9als. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-_---_._______._____.____________.._---.-. ❑ Distance to nearest lot line-------------------------- ---------r------------------------------------------------------------------- ------------- I 9 f--------- Remodeling and/or re airin descrbe --- ------ - ------- ----------------------------------------------------------------------------------•------------.-------------------------------------------------------------------------------------•---------------------------------------- - i ---------------------------------------------------------=•----------------------------------•- I hereby certify that I have prepared this,applicatio l-and.that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of'rahe San ,Joaquin Local Health District. t ' • (Signed)! ------------- ------=•- • -- ----- -- -- ----------------------------------------------fQffo:7_md/or Contractors rX B ----- --- Y•--------------------------------------------•------------------ - (Title)--' C'd ------------.:---- : I (Piot plan, showing size of.lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------, ---------- « DATE ? REVIEWEDBY------------------------------------------ ------------------ ------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--_-------------- -----------------------------------------------------=---------------------- DATE--------------------------------------------- - iAlterations and/or recommendations:_____...__ ----- e--r ----------------------- ----------------------------------- _,r- ..•- --->�� --------•----------------- ---------••----------------------------------------------- ---------------------- ----------------------------------- -•------- --------------2 . - ---------------------------------------------------------•--------------------------------------------------------=------------------------------ t FINAL INSPECTION BY:___--- -------- cam_. Date----- - - ----/ -y/- ----f-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon 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.P.CO.