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FOR OFFICE USE: 12l ------------- l _ _ Permit No. __(.. _ -. APPLICATION FOR SANITATION PERMIT �• � �--._J---__� (Complete in Duplicate) Date Issued -�-' •---- - ----------------`�---.-- This Permit Expires 1 Year From Date Issued I Healfh District for a permit to construct and -install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. ------•------------•---•-------•-----•------••--------••------•----•----- JOB ADDRESS AND LOCATION------ ------ s�----;,-•�*�/•�--- 1----- / Phone----------------------------------- Owner's Name__..----�,1.. •f ` r�- - Address---•-•----.�,�--- ----�-�-----------•---------------- ---------------------------------•--------------------...------------------------------------- , ------- Contractor's Name --, -• --------- --- - •-------------•----------------- Phone ,� __. Leri ' Installation will serve: ,Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _ -_ Number of baths __ .__ Lot size .0 - --• ----------------------- Water Supply: Public system ®Community system [IPrivate E] Depth to Water Tablefl ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado beHardpan ❑� Previous Application Made: (If yes,date--------------------) No R3'r*,�'New Construction: Yes ❑ No R4--FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 fest.) Septic'Tank:r Distance from nearest well-----------------Distance from foundation--------------------Material------ ------...__-______--______-___._._-------- � No. of compartments------ - -- ---Size--------------- - Liquid depth---------------------------Capacity..------------------. Disposal. Field.;, Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line___-______-_.____ 5 4W Number of lines-----------------------------------Length of each line----------------=-------------Width of french--------------- of filter material_-_______.____.____ -Depth of filter material___-._________ _Total length___.___._______-- ------ i Seepage Pit: Distance to nearest well______ '___ Distance f�r ' fou dation_ ,_sem..___.Distan to nearest lot line,/ -___-I ®� Number of pits.----/----------- Lining material__,,1?2'? -Size: Diameter---, -------..Depth_ .--------:-------Cesspool: Distance from nearest well-----------------Distance.from foundation---_______- ---.Lining material-_._.:.________Size: Diameter----------------------1---------------Depth----------------------------------------------------Liquid Capacity----------------------------gaPrivy: Distance from nearest welLI------------- ------------------------------Distance from nearest building__---_..__-_____--______.___.---___-❑ ------=-------Distance to nearest lot line---- Remodeling and/or repairing (describe :__---_--------- -- ------------------------- -----•------•------•-------------------------------- _ ---------------------=---------- _______ _ ------ ------------ --------•-----------------------------------•-------------------------------------•------------------ ------------- I 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 regulations of the San Joaquin Local Health District. _._. (4DwnsTswJ�Pr Contractor) (Signed) ---------- --- -------------------------------------- - - 4G 6 = (Title) BY=--------•-----------•- - (Plot plan, showing size of lot„location of system in anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_. DATE-------`Z-- 7= ' DATE - BUILDING PERMIT ISSUED------------------------------------------- ----------- REVIEWED BY-------------------------------------------------------------------------------------------------------------------- ---------------------------- -------------- � ----------------- DATE---------------------------------------- ---- --------------- _ �. ..,. Alter ions and/or ecammendations-------------------------------------��--------------- ------------------------- - 7 � - -------------------------- = A/< D -Z -a -7 7 FINAL INSPECTION BY:..................../l.----------- Date.. ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 31A 3-'63 F.P.CO.