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FOR OFFICE USE: ------------------------------------- -------- -----------------------------_______________________ APPLICATION 1=0R SANITATION PERMIT Permit No. ------------------------------ --------------------- (Complete in Duplicate) ----------- Permit Ex ares 1 Year From Date Issued Date Issued ---- Application is'hereby made to the San 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. JOB ADDRESS AND LOCATION-----------••----------- �/ r ' y _-- Owner's Name-_-,---------- -------------------------------------- -------------------------------------- Phone-- �� S�a Al Address Phone................. Contractors Name------•------- ------ • GP. �'= - --------- "•----•-•------------••------•--"----•-------.... 1W------- Installation will serve: Residence & Apartment House ❑ Commercial:❑ Trailer Court Ef Motel ❑ Other ❑ , Number of living units: __.f Number of bedrooms __"a_ Number of baths _ Lot size ---------- Wafer _._..__5Water Supply: 1Public -syi em ❑ Community system ❑ Private ® Depth to Water Table Y51t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g HardpanPrevious ❑ PP TYPE OF INSTALLATI 'flf yes, ate-_-_1........... .l No � New Construction: Yes 9 N)I FHA-./VA: Yes No ON`AND SPE � - CIFICATIONS.. (No septic tankf or cesspool permitted-if public sewer is available within 200 feet.) e fisc Tank: tfCfeom fiWel _"---,Distance from foundation s Naoom compartments �_ l Liquid depth______.____ /.�----._Capacity.._ // ! Disposal Field: Distance from nearest well. Lf__Distancel fro foundation-_____/-__f . _ istance to nearest lot line--------- Type of filter material____:7G ----De gh of ch line;- y. Width of trench______ �_� YP er of lines----------------- -- Le p th of�filter�ateri�al------/�--�------total length-------•��-t-'-----------------•-•-- � Seepage Pit: Distance to nearest well______.____-__-___-_-Distance from'foundation___________________.Distance to nearest lot fine-----------------❑ Number of pits----------------------Lining material--------- ------..Size: Diameter--------- -------------Depth----- -------------------------- -C - Cesspool: Distance from nearest weil___*-----------Distance from foundation------------------__Lining material___.__-_______-______ L e ❑ Size: Diameter--------------------------------------Depth------------------------ f Liquid Capacity---------------------------gals, ZO Privy: Distance from nearest well-_------------------------------------------- Disfante from nearest building ❑ Distance to nearest lot line.-----------------------------------------------------"---_------ � Remodeling and/or repairing (describe):------R/ --_- --------------------------------- --------------------------- ---- ----------------- ^+ { - - =•------------------------------•----- ------------------------- ---------•---•------------ ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County yr ordinances, State la , and rules an re ulations_of the San Joaquin Local Health District. + (Signed)---- , ------------------------------------------------------------------------------------------ (Owner and/or Contractor) BY: -------------•----------------------- Title ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildin s, etc., can be laced on reverse side)._ 9 p FOR DEPARTMENT VSE ONLY APPLICATION ACCEPTED BY----------- = --------- DATE--- -------- - ' a - ---E -- - -------------------------- REVIEWED BY . ----------------------••-------------.. DATE_ BUILDING PERMIT ISSUED------------------------------------ - ------------------. DATE-------------------- --iAlterations and/or recommendations___ ______ -_- � --------------- _. -----------------••------•---•---••- -•------••------ --------•--------------------------- ------------ FINAL INSPECTION BY ------- --- - - - --- Date---------- 2 �.s SAIV`JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street e ` 300 West Oak Street 124 Sycamore Street 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t E6-9 rrEVI6ED H•59 F.P.G O.2M 6-60