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----- ---"------------"--- --- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - ---------------------------------------------- (Complete in Duplicate) Date Issued ... -------- ------------------ --------------------------- This permit Expires 1 Year From Date Issued _ d3 Application is hereby made to"the San Joaquin Local Health District for a permit to construct and in�lhthezdwora h07eo�-ocribed This application is made in compliance with Coun Ordinance No. 549. (OLb Srir- tTLa JOB ADDRESS AN }LOCATION� �C �J •• � ,� r� X_-q, Owner's Name.__ -- Phone _4.•- � V.0 Address ------- e�4- -•_ - «r P ---------•--------------------- ------------------------------------ ----------------------- -- -- Contractor's 'Name...-. ___. f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i. Number of living units.:_,..___ Number of bedrooms 4--- Number of baths __I--- Lot size -_----------- - ----------------------- Water Supply: Public system' ❑ Community system ❑ Private gj—V_e�th to ater Table -------- ft. ' i Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ zAdobe❑ Hardpan ❑ } Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/\/A: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.} Tnb: Distance-.;from nearest well-----------------Distance from foundation_-------._-.------.Material------_._.----------.....__...__................. No. of compartments•------ ------------------Size--------------- ---------------Liquid depth---------------- -- Capacity al i Distance from nearest well-- Distance from found _ . ation- _ -_____=Distance to nearest lot line__ ... - Number of lines-_,/ �_ Length of each line--- .........Width of trench.x� <�f - zaTYPe of filter material- -.Total length ria Depth of filter mate ..,�------•-------•-- Seepage Pit: Distance to nearest well---------------_- Distance from fodation___. �u n+ .__....:.....Distance to nearest lot line----------------- + `' ❑ Number of pits----------------------Lining material.............._____. .Size: Diarrieter------------------------Depth-------.-.-.-------------------- 1 Cesspool: Distance from nearest well Distance from foundation--------------------Lining �❑� ,,,�,.. S _ . ` materialy--.-----._--.- .___g---_-_ ize:rDiareter. als .-- gL pc • Privy: Distance from nearest well _______________-_-_______--__._,.Iry----------Distance from nearest"building--------------------------.-------------- F1 s--❑ Distance to nearest lot line-----------------------•--------------------------------------------------------------------------------------------------- Remodeling and/or repairing ,,{clescribe)-------------- •----------- --------•------------•---- -----••------------... il ------------------------------------=---------•-•--------•------- ` ------------------------------------------•--------------------------------•---• -- .� --------- _ /t I±hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County ordinances, State I rules and regulat' ns of the San Joaquin-Local ,ealA District. 5 (Signed)- I2___ -... fl Contractor) F+'. -----• -•-- BY: -------------------------- ----- ...(Title)-------------------------------------------- - ------ (Plot plan, showing size of lot, location of system in relation elfs, buildings, etc an be placed on reverse side). _ I FOR DEPARTMENT USE ON APPLICATION ACCEPTED BY----------------- ----- � DATE = = r� -------- REVIEWEDBY --------• -------------- --------- ------------------------------------------ ---------------------• DATE.------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------••---------------------------- DATE------------------------------------- Alterations and/or recommendations---------------------- ...................................-.......IiA f --- ------------- ................................5-•--.._-_._.-.-..._ -__-_- - _---•__-._.___.. - -_- -- -------- -- -------------------------•------------------------------------------------------•"---___.....__.......___.... ff FINAL INS ---- ---- ------- -- -- -- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT j 130 South American Street 200 West Oak Srreet 124 Sycamore Street 205 West 9th Street j Stockton,Californlo Lodi,California Manteca,California Tracy,California ES 0 REVISED 8-59 2M 6.61 ATLAS :