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F R OFF CE SE: --------'- .. '.f` --------- APPLICATION FOR SANITATION PERMIT Permit No. ...,! -- ------------ --- ---------- -------- ----------------- (Complete in Duplicate) �P Date Issued .__ ----------.l----------------------______.__.__.._. This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549. JOS ADDRESS AND LOCATION.. ------------------ -- ---------------------------------------------------------------• -------------.......---•.......... .- Owner's Name----------- ------ Phone............................... Address-----------Q2-� + /} --------------------------------- -----------------------------------------------=---------------•-•---------------------------------a.---.._.-__--....".... •------------ Contractor's Name------------ ��'"K'� ------------------------------- ------------ -- --------- -•--------------------.. Phone----------------------••--•----•--- .F Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other JR--' l Number of living units:__- Number of bedrooms Number of baths _ Lot size ___ �>+1� ___1� Q.. ................. Water Supply: Public system Poo'Communify system ❑ Private ❑ Depth to Water Table _747 f+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 01<ardpan ❑ Previous Application Made: (If yes,date--------------------I No P<7New Construction: Yes ❑ No FHA/VA: Yes ❑ No ®.— TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Se fie Ta k. Distance from nearest well---- Distance from foundation___ l No. of compartments..----------------- __.__=#;' f-_--__..--_-Capacity_/,�,�-00.-__. Disposal Field: Distance from nearest well____°-------Distance from foundation.-4p--- to nearest lot line__-_-4.7 ... �`� Number of lines_______- _ _ Length of each line___-_ D - � _.Width of trench__s _,r��-.---___.•_- '! Type of filter material/- __ _Depth of filter material...14P�_--------Total length_____?49_*--_-__-___ --------- SeepagegPit: Distance to nearest well _.__Distance.frgm'oup Size: --a,/6 e/-__ i� to nearest lot line__„$--�__..- � �� 1'f�..___.Distance Number of pits------A----•- ---_Linin material: . Depth__A_d----I_________________ Lining \ Cesspool. Distance from. nearest well________________Distance from foundation---.----------------Lining material----._-_____--_______________________. � ❑: Size: Diameter------------------------s--- -------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy:' Distance from nearest well______________ ----------------------------------Distance from nearest build ing-`: ____----------_______..______._. ❑ Distance to nearest lot line----------------------------------------------------`------------------------------------------------•----• -----------••--------------------- Remo elin and/or repairing describe :__..__-._____- elea__A� !............................ ----------I1---------------------------------------------------+----------------------------------- --- -----------------•••---- ------------------------------4.1a� - II ------------------------- ------------------------------ ---------- Ijhereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules and regulation of the San Joaquin Local Health District: I (Sign4 } ✓ ----- Contractor) - ' rale By:__ 00- wo - -------- { } (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-- ----- r---'---- 0`Eti � s ------------------------------ DATE__,. _ /1---p "`----------•---•------------------- y REVIEWEDBY------------------------ --------------------------------------------------------------------------- --------- DATE------------ ---------------------- t$UILD1NG PERMIT ISSUED--- -------------------------------------------------------------• ------ -------------------- DATE-------------------------- ----------------------------••---- Alteraf ions and/or recommend afions------- ---------- - ------------------------------------------------------------------------•------------------------------•--•-----------•-•- --------------- --------- •--•--------------- ------------------------ --------------------- ----. - --- / - /� G._� �__ Z 4?------I----- __________________________ .- FINAL INSPECTION BY:-- Date g l f SAN JOAQUIN LOCAL HEALTH DISTRICT �. 130 South American Street 300 Wast Oak Scree! 124 Sycamore Street 705 West 9th Street Stockton,California Lodi,California Mdnfeea,California Tracy,California r ES-9 REV ED 8-59 F.p.CD.ZM 5-60 Il.