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FOR OFFICE UAl?' , APPLICATION FOR SANITATION PERMIT Permit No. ------------=----------------------- ----------------- (Complete in Duplicate) ------------------------------------------------_--------- This Permit Expires 1 Year From Date Issued Dots 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 Ordinance No. 549. JOB ADDRESS-AND,LOCATION------...f_e.Z------ /...... ....................----------------------_-------- Owner's Name. 1 j2 l Ni. ---------------------- Phone:.._.. tiAddress... i Contractor's Name------ ._.... Phone7 Installation will serve: Residence Apartment House El-, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .,7-- Number of baths ._-,._ Lot size .__._.*,5-Z-7L`za.p-__`---_-----____ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table J,fft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) NOX New Construction: Yes ❑ Nox FHA/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................................................. Yl pp'�I No. of compartments-------------- -----------Size---------------_ '_ Liquid'depth--------_----------------Capacity......_........... •�,- Disposal Field: Distance from nearest well__WD4e� Distance from foundation---Z�_______-Distance to nearest lot li ne'—s........... i fl f f n� Number of lines__________________ ___ Length of each line----�________�(_....Width`•0f trench.____...7-V.................... K•cu,l , 9 Type of filter material...... Deptli'of filter material......f ______.__Tota! length....... , ................. Seepage Pit: Distance to nearest weli____,A1*A)k__Distance from foundation.....Z.O.......Distance to nearest lot line.... ....... _ V Number of pits______ ____________Lining material. +R_L .Size: Diameter-___St- ---__.____.Depth___ Cesspool: Distance from nearest well-----------------Distancefrom foundation--------------------Lining material-------.....________----------_-_-_•_ El Size: Diameter--------------------------------------Depth----•- -- w------------- Liquid Capacity._.. gals. Privy: Distance from nearest well ______________________________________-.--------Distance from nearest building_____._..___--..____-___-______-..--___._. Distance to nearest lot line = ------------ ----= --- -----------------------•-• ----- ----------- l Remodeling and/or repairing (describe): " ___ �Sy_____ ___._ x-x�-1--------------------•--••..•-. w --------------------------- -------------- -tom 1 —__________________________________________________________________---`--____---------------------- ve p 1 Hereby cerci that I hive prepare his application and that the work will be done in accordance with San Joaquin County .�. ordinances, State laws• nd rules an regulatio of the San Joaquin.Local alth' District. `� Owner and/or Contractor (Signed) - -_.._-- • : . / I _. By:--------•---•--•......-•---•----••-----•-•-•••--------------------- r� --(Title)......i4o_ (Plot plan. showing size of lot, location of system in re on to wells, buildings, etc., an be placen reverse side). FOR DEPARTMENT,USE ONLY } �. APPLICATION ACCEPTED BY__--- _--' _-- - ----------- _ DATE_...___- -------------------- REVIEWED BY---------------- --------------- DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------•---------•-- DATE----------------------------------------••---------•----••--- Alteratio s and r recomm s:-------- . --- -- --- ----•-------------- / 0 .------.---e. -------------- ---------------------------------- ------------------------------------------•- ---------1, � " . FINAL INSPECTION BY:. ,X- ----------- 7--------------- Date__ 31 { - --------------- 1 , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 AEVIBED B•59 2M 5-61 AtLAB