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R FFICE USEt /''` . - I��FV --------------- Permit- � No.�� ! APPLICATION FOR SANITATION PERMIT ---------------------- --------_:-----------`" (Complete in Duplicate) P """Date Issued _- -------------------------------- -- ----- 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 co'mpliance with County Ordinance No. 549. �i JOB ADDRESS AN -------- ----- = ----------------- -----------------_------ ------- -•-•----------------------- ------------•--------------------- one Contractor's Name------- .---- d ----------------_---------------Ph Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitsi ___1._..Number of bedrooms -Z--- Number of baths ----- Lot size --------------------------------- Wafer :---------------------------Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4-S-ft. Character of soil to a depth of 3 feet: - Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[---H-ardpan ❑ r Previous Application Made: '(If yes,dote---------------_---) No New Construction: Yes ❑ No [Z,.-<A/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubic sewer is available within- 200 feet.) w " A ' -.. Septic Tank: Distance from nea est'well.. ... ..........Dis1ante from foundation -------------------------------------------------- t" -.------------ - . ---- I. ��r✓ ompartmenis_____.-A '_+, . e`"� _j - to nearest lot line-------•---.-•..-- 6 i - " Size Li uid de th -------------------------Capacity 1. i Disposal Field: Dotance:`from nearest well-----------__ Distance from fou d ------------------- Number of lines Length of each line Width of trench. _ filter material------------------- ----Depth of filter material-----------------------Total length--------------------I--------------------- Seepage Pit. ypance to nearest well---------------- _Distance yfrom foundation..�e)__"".....Dist n� to nearest lot line--`5��---- Type off umber of pits--------�_.._.-------Lining material.--1Diameter esspoo : � Distancefrom nearest well-----------------Distance from foundation------------------- material---.--------------------------------- 0) ❑ � Size: Diameter---------------------------- -.--.---,-Depth--------------- ------•---- ---- - ----------------Liquid Capacity----------------------------gals. S .i Privy: Distance.-.from nearest well..................._._.__--_--___...._---- ..Distance from nearesf.building--------------._----.___...._-..____---.-. ❑ Distance:to.nearest lot line------ -------------------------- - =------i --;-------- --- -------------------------------------"--------------•---------------"---- ----------- Remodeling and/or re airani 'i--- g / p - • 9 (describe-_-- ---a "�_d ' 1-� - - =------ ----- � - "----------.---------------------------------- --- .-.......---;--•--------- ----- -- i i P [ -' � I hereby certify that I haveprepalred this application and that-the work will be done in accordance with San Joaquin County ordinances, State la , an ules and - gu a 'ons of the San Joaquin Local Health District. (Signed___....:_...___. �- - - ----------------(Owner and/or Contractor) r By:------------------ - -- --------- - --------------------------- [ �tle) (plot plan, showin i of lot, location of.system in relation o wells,.buildings, etc., can be placed on reverse side).._.... 1i, li i FOR DEPARTMENT USE ONLY 7r _ ��.rw...-....--rte._- .� �,.r...�,;.:....^��.._r�-�--� •E r' J /L APPLICATION ACCEPTED';$Y lam{ --'�"--- �------------------------ DATE :�-( --------- /-,_- --------------- - iREVIEWED BY----------------------- ---------------------------- ------------------------.-"------------------------------------------ DATE PERMIT ISSUED_'... --------------------------------------------------------------- - DATE------------------.---------------------------------------- 1. Alterations and/or recommendations:--_. = c .' " e-�t• ---..�.-'moi _ " ------- ,..'e ' " 'f!r7S -s ---- -----•-- ------ ------------ � r "-"----- --- - ----------" --"-----•----- --- ------"------------------ "------ ------------- FINAL INSPECTION BY:'------- - - " ------ Date...--- - --------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t c 1601 E.Haxelion Ava.,i ti4 30D Wes+Oak Street 124 Sycamore Street 205 West 91h Street ! }a `. +� Stockton,California Lodi,Cetlifornio `w Manteca California Tracy,California ES 9 REVISED E1-59 3M 3-'r.3 F.P.CC. d,