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---------------- APPLICATION FOR SANITATION PERMIT Permit No. .._../._3. ' ------------------- (Complete in Duplicate) / r This Permit Expires 1 Year From Date issued Date Issued .._ �41v 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___...__.___ -� �1p p 1j Owner's Name. --------------------•--------------------------------------------------------------- -�... ----••-- ` ---------------••--------- --------- --------------- Phone. ._.r:� � Address f ra4- _ li ...........``° ` r -----------------•------------------•-••--•-----•-.... •--•---••---- Contractor's Name.._�isa„____ !! D� i- �----�t-•f�---- �'r'� -------------•_.. Phone � �� ... .t_______________________ Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Metal ❑ Other ❑ Number of living units: 1.___ Number of bedrooms J_ Number of baths / Lot size ------..K.....Z4 .............. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table1011 Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClaY Loam ❑ Clay ❑ Adabq)E�_ Hardpan ❑ Previous Application Made: {If yes,date____________________) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tan� '� Distance from nearest well-_______________ Distance from foundation------------- No. of compartments___._____-._ ...__ Materiel____.______.___...__...._......_.......................................................... ---------Size-----•------•------•---•--•-•--.Liquid depth---•--- --•---------------Capacity Ispos i d- Distance from nearest well.144, ..Distance from foundation_. / �..._ Distance to nearest lot line..__-�-_- Number of lines___... ________________Length of each line_-___ ` a2 ,V 9 ��-----•------.Width of trench..----•--•-•.�� ',-1 Add Type of filter material...- -_._e- P " ;W-------------------- I . _ Depth of filter material____./ ____-_____Total length___..._s5 _-_•--___ ----------- -----------------Seepage Pit: Distance to nearest well----- Distance from foundation............--------Distance to nearest-lot line----------------- El Number of pits--------- --------Lining material--------.--------------Size: Diameter-----------------------Depth-_-----•.------_-..---•- esspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material...............-----------_------ Size: Diameter----- --------------------------------Depth-----------------------•--------- ---------------._Liquid Capacity-------•------------. _._._gals. Priv ❑Y� Distance from nearest well______________________----_-__-__-_--- ---._Distance from nearest building_____.-_____._____----_--_•__--._------••- Distance to nearest lot line-------------- ______ -------------- •---•-------••------- Remodeling and/or repairing (describe): - -----------------•-----••-•--•---- -•-•----...•-•---•--••----•---•--•----.... ------------- ....----- •- ------•- •-•-- i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, i (Signed)_-- -------- ay I!.,� _ ---------- I---Z'y�-_------- -- ay------------------------------•------------••---------...------- - �Contractors {Title} ------------------------ (Plot plan. showing size of lot, location of system in relation to IIs, buildin g , etc., can be pieced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ -� "��,- DATE -'_ (, --------------------- DATE.-/BY----------------- - -------- r` --------------- ------ BUILDING PERMIT ISSUED------------------------------------ --------••-•--------•--------- -------•-------------•--------------------------------...-------------- DATE-----•--•----------•- Alterations and/or recommendations:---------------- ----------------•----•-----_---_-•------ .._...------••--- -------------------- -- - FINAL INSPECTION BY:- - .-�- 1f� / �•77� — / / ` t -- `� - ~— Date-- C •-:l--- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak STntl 124 Sycamore Street Stockton,California 205 Wnf 9th Street Lodi,California Manteca,California Tracy,california ES 9 REVISED g-gg RM 8-61 ATLAS J