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FOR OFFICE USE: -- --- ---- ------- 11111APPLICATION "FOR .SANITATION-PERMIT � - Permit No. ------------------------------------ --------------------- �+ (Complete in Duplica : te) Date issued his Permit Expires 1 Year From Date Issued Application is hereby made to they in Joaquin Local'Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. qe�.0 -- . . JOB ADDRESS AND LOCATION___'__ ------ 1_ -----' - -_--- `i Phone Owner's Name---, d : 1lQl- b Address...---- }� --------••-----------------•---- Phone--�O=C�-.`-��'- [ � f ` Contractor's Name___.-..___�__________________ __.___!__ Installation will serve: `Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other /� .` f Ili/Flat size Number of living units: -- Number of bedrooms ___.__-. Number of baths Water Supply: Public'system' Community sys gem ❑ Private ❑ Depth to Water Tabled- ft. Character of soil to.a`depth of 3 feet: Sand [I Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ,: s .-, _ ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ o Previous Application Made: rhf yes date____....-..-- i - / _ , TYPE OF INSTALLATION. AND L SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 reel.) ( Septic Tank: Distance from nearest welQ/ E--Distance from foundation 'G__ MaterL__ __. '- /- No. of compartments_-- ----------- ---•Size- __I-C - - - Liquid depth--- - ---- - Capacity_t.. _ '� r �- �s!__ _.___.Distance to nearest lot line_______ Dis osal Field- Distance from nearest wellNOME'.Distance from foundation.-/4-m" oundation_____ Number of lines____ Length of each line----0-1- ,r-------Width of trench___ --------------------- Total length-- = N Type of filter material_ r—// -- .-Depth of filter material--- __-.-- �J 1 Seepage Pit: :+Distance to nearest well___--______-____._-_Distance from foundation____________________Distance to nearest lot line___.____._____-.- Jsk _Size: Diameter-------- --------- ❑ =Number of pits----------------------lining material--------------,--- -- p Cesspool:- Distance from nearest well_________________Distance from foundation.-..mLining material....--- als.� ❑ Liquid Capacity---- El Diameter-- =` = `Depth. g Privy: Distance from nearest well___.____--'-.+�1.---------------- ---- Distance from nearest building._:____________------------------ ------ Ditance to nearest lot line. ----- ----- ❑ sh . s { Remodeling and/or repairing (describe�:___afJ- ' ___ __ I hereby certify MM that MM I havem prepared MM this application and that the work will be done in accordance with San Joaquin County _ ordinances, Staff laws, and rules and regulations of the San Joaquin Local Health District. and/or Contractor] � ,/ � �-_ Title-- -�°-- --- ---- ---- -- -- --- By:: -- ---- �...__ (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side]. --�`"—FOR DEPARTMENT USE ONLY ' --------- --- ------- -------------- - DATE..-------1-----�-`�Q -�-- ----- ------ ------- --- APPLICATION ACCEPTED BY------------------------------------------•-- REVIEWED BY - ------ ;: DATE------------- ----- BUILDING PERMIT ISSUED-------------------------- -_____'- DATE Alterations and/or recammen actons_________________________.__..-._- ------------------------- ----------- --------- --------------------- ---- .f s • r ,f —�BYDate v l� FINAL INSPECTION :.-_._._ _'-- --��---------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Holahan Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REV,SE:D 6.59 3M 3-'63 F.P.CC.