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FOR OFFICE USE- mit- ----------- ------- - Pin N5. J -r 3 ra APPLICATION FOR-SANITATION PERMIT .4a ` ' ------------ - (Complete in Duplicate) Date Issued ___---- ------Wap--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County rdinan No. 549. ----------_-------- --t -- JOB ADDRESS AND LOCAT$ ----- ---D- -- �- -a .__..: PhonI`3 r7 Owner s Name t .�7t ----- --- ----- ------•--------- Address------------- , alr -- �1 -----------------------------------------Phon C!7 Contractor's Name___ _� s ___- i Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence ��partment House ❑ ❑ .� T -- Lot size ---9--C e---A------1 d--------- -f! Number of baths __� Number of living units: _�___ Number of bedrooms __-_ t Private �/De th to Water Table&�ft. Water Supply: Public system ❑ Community system ❑ L�f P Adobe ardgan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ,. Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No �HA/VA: Yes No ❑ ❑ { t TYPE OF INSTALLATION AND tSPECIFICATIONS; t No septic tank or cesspodf"permitted if public sewer is available within 200 feet.) ' Se T Distance from nearest well-_______________Distance from foundation--------------------Material---------------.---------------------- ---------- No, of compartments------ ----------r--------Size---------------------------------Liquid depth------------ ----------- Capacity----------•----------- r "-. Distance from faundation___`�________Distance to nearest lot line__ Disposal Field: Distance from nearest well _�- �• - Length of each line_____ .-Q-�-- ---------Width of trench_ ________________________ Number of lines----- _.-, -�_-- gQ ^ t rr -Tota$ length'' --- /�74 _ 'E Type of filter materiel Depth of filter materia4`___-_�_ . ---- P _ Distan e to nearest lot line____0---__._. � Seepage Pit: Distance to nearest well_ r Distance from oundatio s,---1 .------ . d� ------- Size: 'Diameter._ ' Depth-.- _ ------ I Number of p'sts__./----------------Lining material.-lzc. . - .- - Cesspool: Distance from nearest well_________________Distance from foundation.____t_-_.___-__..Lining material..._____._..___-_.___-__________-. Li Liquid Capacity gals. t F1Size: Diameter--------------------------------------Depth - q p Y Privy: Distance from nearest wel$________._._ ------#------ ----Distance from nearest building--------------------------=------------- a _---------------- ; F ❑ l Distance to nearest lot line------------------------- ------------•-- ------------------------------ Remodeling and/or repairing (describe)______ --- ----------------- --------- -------------- --- ------------------------ ---------- -------------------------- ¢ 1 ------------ ----- - - - ------ r ------------------------ --------------------------------------------------------------------- - - ----•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, les a regulations of the San Joaquin Local Health District. -- w r� * --- n p Contractor) Si ped -------- °' i { g )---------•---------------------------- ----: - r I y ,. ---- ------- ---------Title-------------------'`------------- ---------- - . - (Title) j l (Plot plan, showing size of lot, location of system in relation we11s, buildings tc., can be placed on reverse side}. t t }. FOR-DEPARTMENT USE ONLY ,U E� % ------------ DATE ------ �� i APPLICrATION-ACCEPTED BY--__________ ____ _ ~ - REVIEWEDBY-------- ----------------------- ------------ -------------------- :--- ----------- DAT BUILDING PERMIT ISSUED . - ------ --- - Alterations a /or recommendaf ns:_.a_- _ "v ...... ,1 . --------- -- - --------- -- -- - -- ------ - - -- --- -------------- ----------- ---- - - r = ------ FINAL INSPECTION BY:------ ...'_.__.:ti -------- - ------------- Date-----1� �a ------- ---------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasalton Ave. Soo West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 31A 3-'63 F.P.CD.