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FOR E USE: - 1� "-3e APPf_1C -TIbN`FOR: SANITATION PERMIT Permit No. ------ - -------- ---- ------- (Complete in Duplicate) --------------- ----------------- ----------- Date Issued.-__."-/1 --- This Permit Expires 1 Year From Date Issued Ap Thiplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described: s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATi t 1,4-, ----------- --- ------ Owner's Name________________ _ a2 ? ` ------ Phone_ --_--------- ----------- Address-----_---------- ------- - --------- ----------"I------------------------------------------------------------ - Contractor's Name_.. [ - -- ........... --------- Phon / _. ..fA -/-----Q-7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other ❑ Number of living units: ____ Number of bedrooms _./__ Number of baths_/. Lot size -___r1---0 r Water Supply: Public system Comrnunit system a*-t'_-__..�._.. ..— _ ' x .�Q y y ❑ Private ❑ Depth to Water Tabl;rA .ft. Character of soil to a depth of 3 feet: Sand;❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ - Previous Application Made: (If yes,date.__N-__.___.------1 No --- l l5' New Construction: Yes [❑ No ❑i FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank ort cesspool permitted feet.) if public sewer is available within 200 ft.) I r : Septic Tank: Distaricafrom nearest well_________________Distance from foundation-------------------- Material ------------------------------ ❑ No. of compartments ---Size---------------•--------••----..,Liquid depth--------------------------Capacity. Disposal Field: Distance from nearest weloft-V Distance from foundation___ A?-�__-Distance to nearest lot line----% _'e_.-. Number;of lines_________ ..____ Length:of each line___.-, _____________Width of trench__- �r��___.______-- 7ype of filter material-_ / - 0_ -Depth of filter material___ __ r _ l- -----Total length___._.._ CO------------- ----- Seepage Pit: Distance to nearest well__ Distance ffpcq fou ation___-R__.__._____-Distance�to nearest-lot line_:_______._ R' r - Numberyof pits--------/-----------Lining material_'___ __ . Size: Diametet_.__ 30L------- Depth--. 5_. Cesspool: Distance from nearest well S. from foundation--------------------Lining material__.____- ' ❑ Size: Dameter---- ---------------- �---•- r ------------Depth- -------------------- -------- --------------Liquid Capacity---------------------------gals. ; Priv - _ -•... .r.! ; Privy: Dis{,ance from nearest well___--___#._ y �'_-_ "_ Distance from nearest'buildin _-- __._________________ El Distamce.,to�nearast lot line _______-__ - ---------•----------- ,» ------- Remodeling and/or repairing (describe):_._ ------- --------------------•----------- i r .n -- --------- �.. _______________________________ - _______•--__ her - ti -- ------------------------------------•-----------•----••------------------------- - - - f I hereby certify that I have prepared this appat the work will be done in accordance with San Joaquin C lication and thounty ordinances, Stat9jaws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ -- -----•---- ---- _ _ t ---- weer and/or Contractor) " By:------------ ------ -- - - -- -----••-------{Title)------ - --�-- --------------------- ------ -- -�- - - - -------------- showing -� (Plot plan, size of lot, location of syst in relation f wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------r_ _-.c.__. ►-- --- _ �`-�-- -------- �------------------------------------- DATE ._`- c--L REVIEWED BY --- DATE -•--- ------------------------ ----------------•------------•------ BUILDING PERMIT ISSUED--------------------------------------------------------------' --------------------------------------. DATE.------------•------------- Aiterations and/or recommend fians:__._ -------------------- 17 -- --------- --------------- - --------------------------------------------, -----------•-----__--- -------------------------------------- -.-----•------------------------------------------------- -------- ----------- - --------------- - _ '( ------------------- ----- ----- -- FINAL INSPECTION BYr%` f . --- Date- -- ' -- f:--•' SAN JOA '----------- - QUIN LOCAL HEALTH DISTRICT � F 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REVISED 0•59 F.P.0 D.2M 6-60