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f t&d > Wi(T vQQ.bs r4 1 vfzju L.era S ��1�•. 4� � � Q_ IL Sd�� ,ase. �.q� v APP6CATION FOR SANITATION PERMIT Permit No. - --?. -------- (Complete in Duplicate) �S ( 3 /-- V (p Date Issued ___._1_.____f_.-�___ caA 113 6 0 �. Applica+ion is hereby made to the San Joaquin Local Health istric for a permit to construct and install the work herein described. This application is made in compliance witp County Ordinance No. 549. / v _ _4 �� /-------------'t ------ JOB ADDRESS AND LOCATION.. ._ �.__ __-__ ------------------ ---- --- ---- - - - Phone -: = O.z-!�• Address --- 1 r----- --- -- -I— ---------------------- -------------• ='-- Phone.- i8_ � si�` Contractor's Name__ ___ Installation will serve: Residence to Apartment House ❑ Commercial [I Trailer Court ❑/Mot 1 ❑ Other ❑ Number of living units: __.I__-- Number of bedrooms _'Z__ Number of baths A---- Lot size (2r_�� - `----------•----------- Water Supply: Public system ❑ Community system [� Private M/lDepth to Water Table Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeiZ/Hardpan 0 ! Previous Application Made: Yes ❑ No &� New Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.-sewer is available within 200 feet.) c ' Septic Tank: Distance from nearest well_______________ Distance from foundation_---.-`G-_-----.Material- ----- ---__...__.------.-----. No. of compartments Size_ '-._�._--- Liquid depth '_Capacity-.---?,_,a (` '� kkt&t__.Distance to nearest lot 11Pe____rt?_._------- �C 4 Disposa lel : Distance from nearest well- _..{-----_---Distance from foundation__ . i _-_Len th of each line---�Q_-----------------Width of trench__. Z - Number of lines--------�----n---�---�---�--- - -- g - � Type or filter material-__rte--------.Depth of filter materiaL__..t !__..______.Total length--_._____Q--------______________________ ¢ r See �t: Distance to nearest well-.--j--- ----------Distance from foundation_AAU tttP _.Distaance to nearest lot line-10-------- Number of pits_-----I---------------Lining mate ria L� ize: Diam ter--- -------------Deptn._.._�L-±S�------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size: Diameter----------------------------- ------Depth-----------------.--------------::-------- --Liquid .Capacity----------------------------g ❑ Distance from nearest buildin ------------------------------------- g Privy: Distance from nearest well-----------------------------------'-'=--------- g ❑ Distance to nearest lot line-------- --- -------------------- l- ---------- ---------------------------------------------••---------------------- il Remodelin and/or repair ng (des ribe):_ ..._. s = '� --•--�-------- •-----,------ - -- ------------------------------•---------------------------------------------•------•------- --------------------------•---------------------------------------------- I---hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- -------------------= ------------(Owner and/or Contractor) --------- --------------------------------------------- ---------------- By:---------• ------ --------------- --------------UA T, plan, showing size lot, location system in relation to wells, buildings, etc., can be placed on everse side). FOR DEPARTMENT USE ONLY ----- DATE------ ----------- APPLICATION ACCEPTED BY--------------------- -- �� /V � t DATE------------------------ -------------------------- REVIEWEDBY-------------------------------- -- -- -- ------ ---------- BUILDING PERMIT ISSUED------------ ----------------------- DATE-----------:-------------- ---------------------------•----- �'---------- j ' -•--- - IC Alterations and/or r6commendations: -------- ----------f•-------------� L, �....................----------A(4-----` ; ` --------- - _______ __________ .___.___.------------------- -P _____.-_-w-_ -_-_-.-_'_ ._ - --- ------ ---------------•--------------•---•---- ` — Date FINAL INSPECTION BY..._--._._______ ___________ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerio'en Stra®+ 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2m 145446 e.rw000 12-54 ` i